二尖瓣置换术中同期行房颤射频消融术的麻醉和围术期管理

目的 回顾性分析、总结二尖瓣置换术中同期行房颤射频消融术的麻醉和围术期管理重点.方法 我院从2008年10月至2009年7月连续进行该类手术68例,68例患者均诊断为二尖瓣狭窄和/或关闭不全合并房颤.其中男性25例、女性43例,年龄(54±11)岁,体表面积(1.68±0.18)m2,术前房颤的持续时间为(32±22)...

Anesthetic management on mitral valve replacement surgery plus concomitant atrial fibrillation radiofrequency ablation

OBJECTIVE To review the anesthetic and perioperative management methods on mitral valve replacement surgery plus concomitant atrial fibrillation radiofrequency ablation. METHODS From October 2008 to July 2009,68 consecutive patients,including 25 males and 43 females,with mitral valve disease and atrial fibrillation underwent the procedure of mitral valve replacement plus concomitant radiofrequency ablation.The mean age of patients was 54±11 years,mean body surface area was 1.68±0.18 m2 and the mean time of fibrillation atrial before surgery was 32±22 months.Propofol,midazolam,fentanyl,isoflurane and pipecuronium were used to induce and maintain anesthesia level.During the operation,transesophagus echocardiography was used routinely.Cell Saver was also routinely used for blood conservation.RESULTS A total of 68 cases underwent mitral valve replacement,22 cases underwent aortic valve replacement meanwhile and 32 cases underwent tricuspid valvoplasty meanwhile.Radiofrequency time was(20±6) minutes,cardiopulmonary bypass time was(113±44) minutes and cross clamp time was(81±35) minutes.Postoperative mechanical ventilation time was(18.8±8.8) hours,the length of intensive care unit stay was(50±51) hours.There was no death and renal failure.Two patients were re-exploration for bleeding after the surgery.Three patients implanted permanent pace maker because of complete atrioventricular block postoperatively.35(55%) patients were recovery to sinus rhythm in hospital.CONCLUSION Understanding the methods and mechanism of radiofrequency,using proper anti-arrhythmia medicine,and applying intensive rhythm control strategies and blood conservation methods are the key issues during perioperative management.