【摘要】 <正> 我院自1978年5月至1981年5月期间,采用POLYSTAN心肺机及Rygg-Kyvsg-aard氧合袋,于全身体外循环合并中度低温下行直视二尖瓣手术22例,现将其麻醉管理经验介绍如下。一、病例情况:22例中女13例,男9例。年龄33±7.6岁,体重54±7.7kg,心功情况及手术种类见表一,22例中特大心脏者3更多还原

【Abstract】 For three years, since May 1978, utilizing POLYSTAN Heart Lung Machine and Rygg-Kyvsgaard’s Oxygenators, we have performed direct vision intracardiac operation for mitral diseases on 22 patients under total cardiopulmonary by-pass combined with moderate hypothermia, 14 of them performed mitral valve replacement. Our experiences in regard to the anesthesia management are summarized as follows.1. Sufficient preanesthetic medication to make the patient falling into fast asleep constitutes the chief measure to prevent preanesthetic acute heart failure. Inducing anesthesia in patients with Ⅲ-Ⅳ degree of cardiac function （NYHA Ⅲ-Ⅳ） with small quantities of fentanyl （6.4±1.8μg/kg） causes no circulatory depression.2. Diminution of plasma K⁺ is the principal factor causing cardiac arrhythmia. Monitoring of the EKG and plasma K⁺ level will play an important role in the detection and treatment of the disturbances.3. The changes in acid-base balance in this kind of patients mainly are respiratory and metabolic acidosis. The chief cause of metabolic acidosis is the continuous accumulation of the lactates, however, non-lactic acid-base changes, may also occur. Intensive care of respiration, maintaining satisfactory circulation and administering NaHCO₃ solution according to the values of B.E., are the principal measures for the prevention and treatment of the respiratory and metabolic acidosis.4. If after extracorporeal circulation, the blood pressure can maintain at a level of more than 80 mmHg through the regulation of the blood volume, there is no need for administering cardiotonics or inotropic agents which would increase O₂ consumption of the myocardium.5. Infusing total blood, plasma and others to raise plasma oncotic pressure and administering diuretics are effective measures for excreting the superfluous fluids in the body.更多还原