携带永久起搏器患者心脏手术的麻醉方法探讨

目的对携带永久起搏器患者心脏手术中的影响因素和麻醉手术中的管理进行探讨。方法近两年南阳市第一人民医院6例携带永久起搏器的患者接受心脏手术和麻醉。所患心脏疾病：换瓣4例，冠脉搭桥2例，置人永久性起搏器的原因主要是病窦综合症5例，Ⅲ度房室传导阻滞1例。麻醉诱导采用咪唑安定、维库溴胺和芬太尼。术中均使用单极电烙。结果6例患者中术前将起搏器程控为V00起搏模式1例，对起搏器进行临时程控使起搏心率维持在80--90次／分2例，其余3例起搏模式不变06例患者在手术开胸、取内乳动脉及关胸止血过程中，使用单级电刀和电凝，虽然输出功率很低（25～35J），并应用短脉冲放电，但对起搏器仍产生不同程度的干扰，由于问断放电操作，并未对患者循环造成严重影响。手术过程顺利，所有患者术毕均安置心外膜临时起搏器以备不测。结论掌握麻醉手术中对永久起搏器的影响因素和相关并发症，采取正确的管理措施对携带永久起搏器病人在心脏手术中的安全有重要意义。

Anesthetic management of patients with permanent pacemaker in heart operation

Objective To explore influence factors of patients carry!ng permanent pacemaker during the heart operation and anesthesia management in the operation of. Methods In recent 2 years, 6 cases of patients with permanent pace- maker underwent cardiac operation and anesthesia in Nanyang First People~ Hospital. The heart disease they suffered：the valve replacement in 4 cases ,2 cases of coronary artery bypass graft. The cause of permanent pacemaker implantation is mainly sick sinus syndrome in 5 patients, third degree AV block in 1 case. Anesthesia was induced with midazolam, fenta- nyl and vecuronium bromide. Monopolar cautery was used in operation. Results In 6 patients, 1 cases with preoperative programming pacemaker of VOO pacing mode, the pacemaker was programmed to make temporary pacing rate maintained at 80 to 90 times/min in 2 cases,pacing mode was unchanged in the remaining 3 cases. In the process of opening chest operation, getting internal mammary artery and sternal hemostasis, 6 patients were treated by the sing!e stage electric knife and coagulation. Although the output power is very low（25 -35J）, and short pulse discharge＇ was applied, which still interfere pacemaker with different degrees. Due to intermittent discharge operation,it does ：not cause serious influence on the circulation of the patients. The operation went smoothly, all patients were placed temporary epicardial pacemaker postoperatively for fear of accident. Conclusion Mastering the influence faCtors of operation and anesthesia on the per- manent pacemaker and related complications, adopting correct management measures are of great significance to the safe- ty for the patients carrying a permanent pacemaker in cardiac operation.