电视胸腔镜下小儿室缺矫治术的麻醉管理

目的探讨小儿电视胸腔镜下室缺矫治术的麻醉管理方法.方法61例先天性心脏病患儿,年龄3～13岁,均采用单腔气管内插管全麻,整个手术过程通过改良双肺通气方法来暴露术野,分次给予芬太尼镇痛,微泵静注维库溴铵维持肌肉松弛,并根据需要间断吸入异氟醚维持麻醉.结果全组均未出现恶性心律失常、残余漏及低心排出量综合征等并发症.体外循环时间、主动脉阻断时间及术后呼吸支持时间与同期常规正中开胸组相比,差异无统计学意义(P＞0.05);而术后胸液量、输血量及住院时间明显缩短(P＜0.01).结论电视胸腔镜下小儿先天性心脏病手术,术中改良双肺肺通气,加强呼吸管理和肺保护是麻醉管理的关键.

Anaesthesia management of thoracoscopic surgery for ventricular septal defect in pediatrics

Objective To summarize anaesthesia management of thoracoscopic cardiac surgery in pediatric ventricular septal defect. Methods 61 patients, 3-13 years old, with congenital-heart diseases, were operated by thoracoscopic approach. Anaesthesia were performed through single-cavity tube in the trachea, changing ventilate methods to exposure the operation area, giving fentanyl times to ease pain, giving vecuronium through tiny-pump to maintain muscle relaxation, inhaling disconnectedly isoflurane to maintain anaesthesia . Results There was no operative complications such as death,leak, arrhythmia and low heart out-put syndrome. The time of bypass, cross-clamped and ventilation were similar to other 38 cases operated through a mediam sternotomy at the same period(P>0.05), but the volume of drainage and time of hospitalization were significantly less(P<0.01=. Conclusion Changing ventilate methods to expose operation area, strengthen the breathe manage and lung protection are the key of anaesthesia manage for thoracoscopic cardiac surgery in congenital heart diseases.