摘要
目的:总结外科治疗肥厚型梗阻性心肌病的麻醉管理经验。方法:2010年1月至2012年12月外科治疗肥厚型梗阻性心肌病23例,术前应用β受体阻滞剂,采用气管插管全身麻醉,外科切除室间隔心肌疏通左心室流出道,二尖瓣结构功能异常者行二尖瓣成形或置换术。术中采用经食管超声心动图(TEE)监测指导麻醉管理和外科治疗。结果:全组患者麻醉过程中血流动力学平稳,TEE监测提示左心室流出道疏通满意。同期行二尖瓣成形术6例,其中2例TEE监测提示二尖瓣前叶收缩期前向运动、二尖瓣中大量返流改行二尖瓣置换术。共行二尖瓣置换术8例,TEE监测提示人工二尖瓣功能良好。术后并发症包括完全性左束支传导阻滞7例,Ⅲ°房室传导阻滞、室间隔穿孔、活动性出血、心力衰竭、肾功能衰竭各1例。术后死亡2例,死亡原因均为脑卒中。结论:应用β受体阻滞剂、维持足够的麻醉深度有助于减轻左心室流出道梗阻,术中TEE监测对血流动力学管理和手术策略制定具有重要的指导意义。
Objective To summarize the experience on anesthetic management in surgical treatment for hypertrophic obstructive cardiomyopathy （HOCM）. Methods 23 patients with HOCM who had undgergone surgical treatment during the period of January 2010 to December 2012 were included in this study. Preoperative beta blockers were routinely administered and general anesthesia were performed. The myocardium of the left ventricular septal was surgically removed to decrease the left ventrieular outflow tract gradient. Mitral valve plasty or replacement was performed on patients with abnormal mitral valve structure and function. Anesthetic management and surgical process were guided by intraoperative transesophageal echocardiography. Results Hemodynamics was stable during anesthesia. Transesophageal echocardiography indicated that the left ventricular outflow tract gradients were satisfactory in all patients after surgery. Mitral valve plasty was performed in 6 patients ; however, 2 of them were converted to mitral valve replacement because transesophageal echoeardiography indicated systolic anterior motion of the anterior mitral leaflet and moderate-to-severe mitral regurgitation. A total of 8 patients underwent mitral valve replacement. The function of artificial mitral valves was ideal by transesophageal eehoeardiography. The postoperative complications included complete left bundle branch block in 7 patients, and complete atrioventricular block, ventricular septal rupture, active bleeding, heart failure and renal failure in one patient, respectively. Two patients died from postoperative stroke. Conclusions Beta blocker administration and adequate deep anesthesia may help to reduce the left ventricular outflow tract obstruction. Intraoperative transesophageal echocardiography monitoring is of important significance to guide hemodynamic management and establishment of surgical strategies.
出处
《实用医学杂志》
CAS
北大核心
2013年第20期3373-3375,共3页
The Journal of Practical Medicine
基金
卫生部卫生行业科研专项(编号:200902001)
关键词
肥厚型梗阻性心肌病
心脏手术
麻醉
经食管超声心动图
Hypertrophic obstructive cardiomyopathy
Cardiac surgery
Anesthetic management
Transesophageal echocardiography
