小型猪体外循环下心脏手术的麻醉

目的 研究医学手术实验用小型猪体外循环下心脏手术的麻醉管理及麻醉效果.方法 实验用小型猪34例,分为CPB下停跳组手术组(停跳组,18例)及CPB下并行手术组(并行组,16例),行自体心包片三尖瓣置换术.记录实验中麻醉药物及血管活性药用量,基础麻醉、麻醉维持及麻醉苏醒时间,术后3天、一周存活状况等,并评价基础麻醉及全麻效果.结果 34例均在全麻下顺利完成手术,各期血流动力学平稳,仅停跳组一例术后3天内死亡,存活率97.1%,麻醉效果良好.结论 合理的麻醉药物与血管活性药物的联合应用,仔细的临床观察与正确而迅速的处理是小型猪体外循环下心脏手术麻醉的关键.     

主动脉瓣关闭不全合并巨大左心室麻醉的处理

目的 总结既往主动脉瓣关闭不全合并巨大左心室的麻醉经验.方法 术前30 min肌注吗啡10 mg,东莨菪碱0.3 mg.根据患者反应和血流动力学变化,静脉给予依托咪酯0.1～0.2mg/kg,舒芬太尼1μg/kg,哌库溴铵0.1 mg/kg分次给药,缓慢诱导经口明视插管.根据血气结果调整呼吸参数,维持术中血气在正常范围.吸入1.0%～1.5%异氟醚,间断静脉注射舒芬太尼和哌库溴铵维持麻醉.连续监测心电图、有创血压、脉搏血氧饱和度、呼吸末二氧化碳分压、中心静脉压、体温.结果 术后均无室颤及其他恶性心律失常发生,均康复出院.结论 术前处理重点保证足够的前负荷,维持较快的心率,适度减轻后负荷,适度强心.术后处理重点保证足够的前负荷,早期继续使用多巴胺等正性肌力药物进行辅助,使用硝酸甘油扩张冠脉.     

术后全麻恢复期多次气管插管及长时间保留气管导管诱发婴儿气管狭窄1例

患儿,女性,3个月,体重3.4 kg,因"咳嗽、喘息7 d,加重1 d入院".听诊胸骨左缘3～6肋间闻及3/6收缩期杂音,超声心动图示:左心房增大,室间隔膜周至嵴上回声失落11mm,左向右低速双向分流,房间隔卵圆孔处回声失落3mm,左向右分流,估测肺动脉压50 mm Hg(1 mm Hg=0.133 kPa),诊断为房间隔缺损和室间隔缺损.拟在全麻体外循环下行房间隔缺损修补术和室间隔缺损修补术.血常规、血生化指标及心电图未见异常.     

主动脉瓣关闭不全合并巨大左心室麻醉的处理

Objective To retrospectively review the experience of anesthesia for aortic valve insufficiency complicated with extremely dilated left ventricle.Methods The patients were premedieated with morphine 10 mg and scopolamine 0.3 mg IM.Anesthesia was induced with etomidate 0.1-0.2 ms/ks.sufentanil 1μ/kg and pipecuronium 0.1 mg/kg.After the patients were intubated,anesthesia wag maintained beween 1.0%and 1.5% isoflurane and intermittent Ⅳ boluses of sufentanil and pipecuronium.ECG,direct BP,SpO2,PET CO2,CVP and body temperature were monitored during anesthesia.Result All patients Were rehabilitated without ventricular fibrillation and arrhythmia.Conlusions Measures are taken before the surgery to maintain preload,increase heart rate,reduce afterload moderately and maintain myocardial contractility.After the surgery,maintenance of preload is helpful for ensuring adequate forward flow and benefcial to patients using dopamine and nitrolycerin.     

主动脉瓣关闭不全合并巨大左心室麻醉的处理

Objective To retrospectively review the experience of anesthesia for aortic valve insufficiency complicated with extremely dilated left ventricle.Methods The patients were premedieated with morphine 10 mg and scopolamine 0.3 mg IM.Anesthesia was induced with etomidate 0.1-0.2 ms/ks.sufentanil 1μ/kg and pipecuronium 0.1 mg/kg.After the patients were intubated,anesthesia wag maintained beween 1.0%and 1.5% isoflurane and intermittent Ⅳ boluses of sufentanil and pipecuronium.ECG,direct BP,SpO2,PET CO2,CVP and body temperature were monitored during anesthesia.Result All patients Were rehabilitated without ventricular fibrillation and arrhythmia.Conlusions Measures are taken before the surgery to maintain preload,increase heart rate,reduce afterload moderately and maintain myocardial contractility.After the surgery,maintenance of preload is helpful for ensuring adequate forward flow and benefcial to patients using dopamine and nitrolycerin.