【摘要】 目的探讨胸腔镜体外循环(CPB)下心脏手术的麻醉管理方法。方法选择30例心脏病患者,术前心功能纽约心脏病协会(NYHA)分级为Ⅰ～Ⅲ级,采用双腔或单腔气管插管静吸复合全麻,手术的主要步骤通过单肺通气来暴露术野,分次给予舒芬太尼镇痛,顺苯磺酸阿曲库铵维持肌肉松弛,微泵静脉注入丙泊酚镇静,并根据需要间断吸入七氟烷维持麻醉。结果手术时间120～300min,平均(208.1±87.5)min,转机时间60～211min,平均(134.7±64.2)min,阻断时间30～120min,平均(74.9±43.5)min,复温后29例自动复跳,28例患者当日拔除气管导管,全部患者住院5～8d,平均(7.1±0.7)d,均顺利出院。结论胸腔镜下心脏手术,创伤小、恢复快;合理选择麻醉药物、加强呼吸管理和肺保护将有助于患者术后早期拔管;完善的单肺通气管理和循环管理是此类手术麻醉管理的关键。更多还原

【Abstract】 Objective To summarize anaesthesia management of thoracoscopic cardiac surgery with cardiopulmonary bypass(CPB).Methods 30 patients with heart diseases were operated by thoracoscopic approach.Anaesthesia were performed through double-cavity tube or single-cavity tube in the trachea.Exposured the operation area by one-lung ventilation,gived sufentanil times to ease pain,gived atracurium to maintain muscle relaxation,gived propofol through tiny-pump to Sedation,inhaling disconnectedly isoflurane to maintain anaesthesia.Results The duration of surgery ranged from 120 to 300 minutes,and the average level was(208.1±87.5)minutes.The duration of cardiopulmonary bypass ranged from 60 to 211 minutes,and the average level was(134.7±64.2)minutes.The blocking duration of the ascending aorta ranged from 30 to 120 minutes,and the average level was(74.9±43.5)minutes.With 29 cases of auto-resuscitation after rewarming and 28 patients extubation on the same day,All the patients were discharged,hospitalized 5～8 days,and the averge level was(7.1±0.7)days.Conclusion Due to less trauma and quicker recovery of thoracoscopic cardiac surgery,reasonable election of anesthetic drugs and intensive breathing management and lung protetion could be helpful to early tracheal extubation and recover of patients.General intravenous anesthesia,close monitoring,and complete one-lung ventilation and circulation management are key steps for the success of thoracoscopic cardiac surgery.更多还原