目的:本文回顧性分析總結(jié)32例心臟瓣膜置換術(shù)同期改良迷宮術(shù)患者的麻醉處理。方法:32例瓣膜病合并心房顫動患者,ASA分級Ⅱ-Ⅳ級,心功能ⅢⅣ級,采用以芬太尼為主的全身麻醉,術(shù)中以硫酸鎂和艾司洛爾調(diào)控應(yīng)激反應(yīng),復(fù)溫后多聯(lián)合使用多巴胺或(和)多巴酚丁胺5～10μg/kg·min、硝酸甘油或硝普鈉0. 5～5μg/kg·min等血管活性藥物以達(dá)到擴(kuò)張血管增強心肌收縮力、降低心臟負(fù)荷、維持循環(huán)穩(wěn)定的目的。停機后預(yù)防性安置心外膜起搏導(dǎo)線,使用異丙腎上腺素后心率仍慢者,及時運用臨時起搏,保證有效的心肌收縮和穩(wěn)定的心率。結(jié)果:射頻消融時間為32±5分鐘,主動脈阻斷時間89±12分鐘; 體外循環(huán)時間109±20分鐘。心臟自動復(fù)跳29例, 電除顫復(fù)跳3例, 32例患者術(shù)后均為竇性心律。5例患者使用臨時起搏器。結(jié)論:完善的術(shù)前準(zhǔn)備和圍術(shù)期重視心肺功能的支持治療, 合理調(diào)控應(yīng)激反應(yīng)等措施是手術(shù)成功的重要基礎(chǔ)。
引用本文： 黃建新,王瑜,蘭志勛,李祥奎. 心臟瓣膜置換術(shù)同期改良迷宮術(shù)的麻醉處理. 華西醫(yī)學(xué), 2009, 24(7): 1690-1692. doi: 復(fù)制
| 1. | ABREU F ILHO C A, L ISBOA L A, DALLAN L A, et al. Effectiveness of the maze procedure using cooledtip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease[J]. Circulation, 2005, 112 (9 Supp l):120-125. |
| 2. | 湯服民,劉聰霞,吳鐵軍. 射頻消融術(shù)治療風(fēng)心病瓣膜置換術(shù)中心房纖顫[J]. 實用醫(yī)藥雜志,2008,25 (6):681-682. |
| 3. | 吳清玉主編. 心臟外科學(xué)[M]. 濟(jì)南:山東科學(xué)技術(shù)出版社,2003:143. |
| 4. | 胡小琴主編. 心血管麻醉及體外循環(huán)[M]. 北京:人民衛(wèi)生出版社, 1999:716. |
| 5. | ATLEE J L, 3RD, BOSNJAK Z J. Mechanisms for cardiac dysrhythmias during anesthesia[J].Anesthesiology,1990,72:347-374. |
| 6. | LINDEBURG T, SPOTOFT H, BREDGAARD SORENSEN M, et al. Cardiovascular effects of etomidate used for induction and in combination with fentanylpancuronium for maintenance of anesthesia in patients with valvular heart disease[J]. Acta Anaesthesiol Scand, 1982,26:205-208. |
| 7. | 賈秀紅.鎂缺乏與心力衰竭[J].國外醫(yī)學(xué)兒科學(xué)分冊,1993,20(6):297-300. |
| 8. | 金惠銘.病理生理學(xué)[M].第五版.北京:人民衛(wèi)生出版社,2000:41-45,108-110. |
| 9. | MAYSON S E, GREENSPON A J, ADAMS S,et al. The changing face of postoperative atrial fibrillation prevention:a review of current medical therapy[J]. Cardiol Rev, 2007,15(5):231-41. |
| 10. | 陳忠堂. 圍術(shù)期的心肌保護(hù)[J]. 國外醫(yī)學(xué)麻醉學(xué)與復(fù)蘇分冊, 1985, 6:173. |
- 1. ABREU F ILHO C A, L ISBOA L A, DALLAN L A, et al. Effectiveness of the maze procedure using cooledtip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease[J]. Circulation, 2005, 112 (9 Supp l):120-125.
- 2. 湯服民,劉聰霞,吳鐵軍. 射頻消融術(shù)治療風(fēng)心病瓣膜置換術(shù)中心房纖顫[J]. 實用醫(yī)藥雜志,2008,25 (6):681-682.
- 3. 吳清玉主編. 心臟外科學(xué)[M]. 濟(jì)南:山東科學(xué)技術(shù)出版社,2003:143.
- 4. 胡小琴主編. 心血管麻醉及體外循環(huán)[M]. 北京:人民衛(wèi)生出版社, 1999:716.
- 5. ATLEE J L, 3RD, BOSNJAK Z J. Mechanisms for cardiac dysrhythmias during anesthesia[J].Anesthesiology,1990,72:347-374.
- 6. LINDEBURG T, SPOTOFT H, BREDGAARD SORENSEN M, et al. Cardiovascular effects of etomidate used for induction and in combination with fentanylpancuronium for maintenance of anesthesia in patients with valvular heart disease[J]. Acta Anaesthesiol Scand, 1982,26:205-208.
- 7. 賈秀紅.鎂缺乏與心力衰竭[J].國外醫(yī)學(xué)兒科學(xué)分冊,1993,20(6):297-300.
- 8. 金惠銘.病理生理學(xué)[M].第五版.北京:人民衛(wèi)生出版社,2000:41-45,108-110.
- 9. MAYSON S E, GREENSPON A J, ADAMS S,et al. The changing face of postoperative atrial fibrillation prevention:a review of current medical therapy[J]. Cardiol Rev, 2007,15(5):231-41.
- 10. 陳忠堂. 圍術(shù)期的心肌保護(hù)[J]. 國外醫(yī)學(xué)麻醉學(xué)與復(fù)蘇分冊, 1985, 6:173.