胸主动脉夹层动脉瘤手术的麻醉处理

目的：总结StanfordA型主动脉夹层（aorticdissection,AD）动脉瘤手术的麻醉经验,探讨该类手术的麻醉策略。方法：2012年1月至2013年1月对55例StanfordA型AD患者在深低温停循环（deep hypothermic circulatory arrest,DHCA）加选择性脑灌注下行升主动脉及全主动脉弓置换加降主动脉内支架植入术。全部病例采用全身麻醉,气管插管。术中密切监测各项生命体征、血流动力学指标、脉氧,维持呼吸、循环功能以及内环境稳定。结果：体外循环时间162～493（255．3l±42．36）min;升主动脉阻断时间86～282（170．61±43．58）min;深低温停循环时间13～55（36．23±18．14）min。55例患者术后均返回监护室,住院死亡8例,其中1例于次日因出血过多及心功能衰竭死亡,2例于术后8～10d死于低心排,4例术后死于感染、多脏器功能衰竭,l例术后64d死于脑梗、肝肾功能衰竭。其余均治愈出院。结论：加强术中重要脏器及血液保护是减少术后并发症和降低死亡率的关键。

Anesthetic management of aortic dissection operation

Objective： To summarize the anesthetic management experiences of patients with Stanford A aortic dissection（AD） undergoing surgical treatment under cardiopuhnonary bypass （CPB）. Methods： From January 2012 to January 2013, a total of 55 patients with Stanford A AD underwent replacement of the ascending aorta and aortic arch, implantation of descending aorta stent under CPB with deep hypothermic circulatory arrest（DHCA.） and selective cerebral perfusion. All the patients underwent general anesthesia and endotracheal intubation. In the operation, we closely monitored the hemodynamic parameters, electrocardiogram and oxygen saturation. We maintained stable breathing, circulation and internal environment. Results： CPB time was 162-493 （255.31 ± 42.36） rain and aortic cross- clamp time was 86- 282 （ 170. 61± 43. 58） min. The time of DHCA was 13- 55（36.23 ± 18.14） min. All the patients were sent to intensive care unit. Eight patients died. Cause of death after the operation was respectively bleeding and heart failure, heart failure, infection and muhiple organ failure, cerebral infarction and liver and kidney failure. Conclusion： Strengthening the vital organs and blood protection is the key to reduce the postoperative complications and mortality.