全胸腔镜下房、室间隔缺损修补术后手术室内拔管的临床观察

目的 探讨全胸腔镜下房、室间隔缺损修补术后即刻手术室内拔管的安全性、可行性. 方法 回顾性分析聊城市人民医院2009年5月～2013年3月实施全胸腔镜下房、室间隔缺损修补术286例,总结麻醉方法、手术及体外循环特点、术毕即刻手术室内拔管的实施情况及术后转归情况,根据气管拔管时间分为手术室内拔管组（OR组）和重症监护室（ICU）拔管组（ICU组）,比较两组患者的一般资料和手术情况. 结果 所有患者均手术顺利,220例（76.9％）术毕即刻在手术室内拔除气管导管,其中有2例（0.9％）拔管后15 min内需要再插管.ICU组的术前平均肺动脉收缩压（pulmonary arterial systolicpressure,PASP）[（50± 10） mmHg（1 mmHg=0.133 kPa）]高于OR组[（45±8） mmHg] （P＜0.05）,且术前PASP＞60 mmHg患者所占的比例也较高（14％与6％）（P＜0.05）.ICU组术中芬太尼的总用量[（10±4） μg/kg],高于OR组[（6±4）μg/kg]（P＜0.05）,两组单位时间内芬太尼的用量差异无统计学意义.与ICU组比较,OR组的体外循环时间、主动脉阻断时间及手术时间明显缩短（P＜0.05）.术后均无严重并发症发生,顺利出院. 结论 术毕即刻手术室内拔管用于全胸腔镜下房、室间隔修补术是安全、可行的;术前肺动脉高压、术中芬太尼的用量、体外循环及手术时间是实施手术室内拔管的影响因素.

Application of ultra-fast track anesthesia in patients undergoing total thoracoscopic closure of congenital heart defects

Objective To investigate the safety and feasibility of immediate extubation after total thoracoscopic closure of atrial or ventricular septal defects.Methods Clinical and operational data of 286 patients were retrospectively analyzed.Atrial or ventricular septal defects were closed via a totally thoracoscopic approach.Summary the feature of anesthesia,operation,cardiopulmonary bypass and immediate extubation,postoperative outcomes of the patients.The patients were divided into two groups：OR group and ICU group according to the time of extubation.The general characteristics,clinical and operation data were recorded and compared between two groups.Results All the operations were successful and all patients were alive.Immediate extubation in the operating room was performed in 220 （76.9％） patients,in which 2 （0.9％） patients was performed re-intubation in the operating room within 15 min of the initial extubation.A delayed extubation was completed in the intensive care unit in the remaining 66 patients.There was no significant difference in the age,sex,body weight,or type of congenital heart defect between two groups.However,the preoperational mean pulmonary arterial systolic pressure （PASP） was higher in the ICU group [（50±10） mmHg（1 mmHg=0.133 kPa）]than that in OR group [（45±8） mmHg] （P＜0.05）,and more patients in the ICU group had severe preoperational pulmonary hypertension [14 vs 6（P＜0.05）].The total dosage of fentanyl used during the surgery was lower in the OR group [（10±4） μg/kg vs （6±4） μg/kg （P＜0.05）].However,there was no significant difference in the dosage of fentanyl per unit time between two groups.The cardiopulmonary bypass time,aortic cross clamp time,total duration of the surgerywere shorter and the dosage of fentanyl used during the surgery was lower in the OR group（P＜0.05）.In OR group,the rates of postoperative sedation and analgesic were shorter than those in ICU group.There was no death and major complications in all patients.Conc