摘要
目的总结胸腔镜体外循环心脏手术中实施超快通道麻醉的经验。方法回顾性分析2011年1月至2014年12月广东省人民医院胸腔镜体外循环心脏手术实施超快通道麻醉患者的围术期资料。结果 2011年至2014年我院共行胸腔镜体外循环心脏手术1 031例,重症监护室床位周转困难时,选择35例患者实施超快通道麻醉,其中33例(94.3%)在手术室内拔除气管插管。手术类型包括房间隔缺损修补术28例,同期三尖瓣成形术12例;室间隔缺损修补术1例;二尖瓣置换术4例,同期三尖瓣成形术3例。成功实施超快通道麻醉的患者术后重症监护室滞留时间(3.9±1.8)h、住院时间(4.5±1.9)d。1例患者术后再次气管插管行胸腔镜下止血,其余患者无需再次气管插管。未能在手术室拔除气管插管的2例患者分别为苏醒延迟和咽后壁活动性出血。全组患者无死亡及严重并发症发生。结论胸腔镜体外循环心脏手术中能够安全地实施超快通道麻醉,该技术有助于节约医疗资源、加快患者康复。
Objectives To summarize the experience of ultra-fast-track anesthesia in thoracoscopic cardiac surgery with cardiopulmonary bypass. Methods The clinical data of patients who underwent ultra-fast-track anesthesia during thoracoscopic cardiac surgery from January 2011 to December 2014 in Guangdong General Hospital were reviewed retrospectively. Results From 2011 to 2014,1 031 patients underwent thoracoscopic cardiac surgery with cardiopulmonary bypass in Guangdong General Hospital. All the operations were performed through intravenous and inhalation combined anesthesia with double-lumen endotracheal intubation. Femoral arterial and venous cannulation and percutaneous superior vena cava cannulation were used for peripheral cardiopulmonary bypass. Ultra-fast-track anesthesia was performed in 35 patients when the beds in intensive care unit were not enough. The double-lumen endotracheal tubes were successfully removed for 33 patients （94.3%） in the operation room. The surgical procedures included atrial septal defect repair in 28 patients, ventricnlar septal defect repair in 1 patient and mitral valve replacement in 4 patients. The concomitant procedure was tricuspid valve plasty in 15 patients. The lengths of intensive care unit stay and hospital stay postoperatively were （3.9± 1.8 ） h and （4.5± 1.9 ） d respectively. One patient required tracheal reintubation because of re-exploration for bleeding with thoracoseopy. Tracheal extnbation was not successfully performed immediately after operation in 2 patients who encountered delayed recovery and active bleeding in posterior pharyngeal wall. There was no death or severe complication happened in patients undergoing ultra-fast-track anesthesia. Conclusions Ultra-fast-track anesthesia is a safe technique in thoracoscopic cardiac surgery with cardiopulmonary bypass, This technique is useful to save medical resources and promote recovery for patients.
出处
《岭南心血管病杂志》
2016年第2期170-173,共4页
South China Journal of Cardiovascular Diseases
基金
"十二五"国家科技支撑计划课题(项目编号:2011BAI11B19
2011BAI11B22)
关键词
超快通道麻醉
体外循环
胸腔镜手术
心脏手术
ultra-fast-track anesthesia
cardiopulmoanry bypass
thoracoscopic surgery
cardiac surgical procedure
