机器人辅助心脏手术的麻醉管理

目的对机器人辅助心脏手术的麻醉方法进行总结和讨论。方法2007年1月至11月,使用da Vinci S手术系统共完成心脏手术44例,其中房间隔缺损修补22例、冠状动脉搭桥17例、二尖瓣成形3例和左房粘液瘤摘除2例。所有患者在麻醉诱导后插入左侧双腔支气管导管,在da Vinci S系统使用过程中实施单肺通气,其中房间隔缺损修补术、二尖瓣成形术和左房粘液瘤摘除手术均在体外循环下进行。术中监测食道超声、呼吸功能和血流动力学变化。结果所有患者麻醉及手术过程顺利,围手术期无死亡病例。麻醉时间（297.6±52.5）min,升主动脉阻断时间（51.5±27.3）min,体外循环时间（97.4±38.6）min 气管导管拔出时间（5.6±2.5）h,ICU停留时间（2.5±1.3）d,术后平均住院时间（6.2±2.4）d。术中失血量（92.5±35.2）ml,术后引流量（60.5±21.3）ml。结论机器人辅助心脏手术的麻醉方法复杂,术中对呼吸和循环系统的影响明显,对麻醉技术和管理方法是一项新的挑战。

Anesthesia for Robotic Cardiac Surgery with Da Vinci S System

OBJECTIVE To study the anesthesia for robotic cardiac surgery with da vinci S system. METHODS Between January 2007 and November 2007 ,forty- four patients were underwent robotic cardiac surgery using the da Vinci system, including 22 cases of ASD repair, 17 cases of CABG,3 cases of mitral valve annuloplasty and 2 cases of left atrial myoxoma extirpation. After induction of anesthesia,a left - sided double - lumen endotracheal tube was positioned to allow single - lung ventilation during intra -operative procedure. ASD repair, mitral valve annuloplasty and left atrial myoxoma extirpation were completed under extracorporeal circulation. TEE,hemodynamics and respiratory function were routinely monitored during operation. RESULTS All patients could tolerate the anesthesia for robotic cardiac surgery, and there was no hospital mortality. The anesthesia time was 297.6 ± 52.5 min, aortic cross - clamp time was 51.5±27.3 min, CPB time was 97.4 ± 38.6 min, tracheal catheter extration time was 5.6 ± 2.5 h, ICU stay was 2.5 ± 1.3 d and post - operative hospital stay was 6, 2± 2.4 d. The volume of lose blood in operation was 92.5±35.2ml, the volume of post - operative drainage was 60.5 ± 21.3 ml. CONCLUSION The anesthesia for robotic cardiac surgery with da vinci S system is multiplicity, the hemodynamics and respiratory function are extremely instability, it is a new challenge for the technology and management of anesthesia.