全胸腔鏡下二尖瓣置換術麻醉體會_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

彭玲 ¹ , 李霞 ¹ , 郭應強 ² ,  魏蔚 ¹

1. ;
2. ;

Corresponding?author：

魏蔚, Email: 111weiwei@sohu.com

Keywords：

麻醉; 電視胸腔鏡; 二尖瓣置換術

DOI：

10.7507/1007-4848.20150023

Video：

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目的探討全胸腔鏡下二尖瓣置換術的麻醉心得。方法回顧性分析2011年10月至2012年7月四川大學華西醫院擬在全胸腔鏡下行二尖瓣置換術7例患者的臨床資料。男4例、女3例，年齡19～53（34.17±5.58）歲，體重42～69（56.00±3.69）kg。心功能根據紐約心臟協會（NYHA）分級為Ⅱ～Ⅲ級，術前心電圖顯示均為竇性心律，超聲心動圖檢查提示，以二尖瓣狹窄病變為主3例，以二尖瓣反流病變為主4例。采用雙腔氣管內插管，靜脈吸入復合全身麻醉，麻醉維持以異丙酚4～10 mg（/kg·h）靜脈輸注，間斷給予舒芬太尼和維庫溴銨維持鎮痛肌松。在食管超聲引導下采用右側股動靜脈插管建立體外循環，主動脈阻斷后行主動脈根部順行性灌注心肌保護液。結果 7例患者中有6例在全胸腔鏡輔助下順利完成二尖瓣置換術，1例中轉開胸完成二尖瓣置換術。6例行全胸腔鏡下二尖瓣置換術患者主動脈阻斷時間71～144（112.33±9.90）min，體外循環（CPB）時間97～180（150.33±11.60）min，手術時間200～300（251.67±13.52）min，術后拔管時間8.0～20.5（14.37±2.06）h，住ICU時間42.5～53.2（47.65±1.42）h，住院時間11～16（14.17±0.79）d。術后均無二尖瓣機械瓣瓣周漏，無血腫、感染、肺不張等嚴重并發癥，無死亡。結論對于電視胸腔鏡下二尖瓣手術的麻醉，充分的術前評估和麻醉前準備是基礎，術中充足的大腦灌注和靜脈引流是重點，經食管超聲心動圖的指導作用是關鍵。

Citation： 彭玲, 李霞, 郭應強, 魏蔚. 全胸腔鏡下二尖瓣置換術麻醉體會. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(1): 84-87. doi: 10.7507/1007-4848.20150023 Copy

1.	?Chitwood WR Jr, Elbeery JR, Chapman WH, et al. Video-assisted minimally invasive mitral valve surgery:the "micro-mitral" operation. J Thorac Cardiovasc Surg, 1997, 113(2):413-414.
2.	Modi P, Hassan A, Chitwood WR Jr. Minimally invasive mitral valve surgery:a systematic review and meta-analysis. Eur J Cardiothorac Surg, 2008, 34(5):943-952.
3.	Maisano F, La Canna G, Colombo A, et al. The evolution from surgery to percutaneous mitral valve interventions:the role of the edge-to-edge technique. J Am Coll Cardiol, 2011, 58(21):2174-2182.
4.	Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(3):797-802.
5.	周和平, 孫國成, 陳濤, 等. 全胸腔鏡下二尖瓣置換的體外循環管理. 中國體外循環雜志, 2011, 9(4):209-210.
6.	程云閣, 王躍軍, 顧劍民, 等. 全胸腔鏡下二尖瓣置換術的臨床經驗總結. 嶺南心血管病雜志, 2007, 13(5):321-323.
7.	Sostaric M, Gersak B, Novak-Jankovic V. Early extubation and fasttrack anesthetic technique for endoscopic cardiac surgery. Heart Surg Forum, 2010, 13(3):E190-E194.
8.	韋華, 鄧勁松, 李家勝, 等. 電視胸腔鏡下二尖瓣置換術麻醉期呼吸管理. 中國廠礦醫學, 2008, 21(5):535-536.
9.	陳健, 戴雙波. 電視胸腔鏡二尖瓣置換術93 例麻醉體會. 福建醫藥雜志, 2012, 34(4):126-128.
10.	Kiaii B, Bainbridge D, Fernandes P. Surgical, anesthetic, perfusionrelated advances in minimal access surgery. Semin Cardiothorac Vasc Anesth, 2007, 11(4):282-287.
11.	Onnasch JF, Schneider F, Falk V, et al. Five years of less invasive mitral valve surgery:from experimental to routine approach. Heart Surg Forum, 2002, 5(2):132-135.
12.	Savini C, Camurri N, Castelli A, et al. Myocardial protection using HTK solution in minimally invasive mitral valve surgery. Heart Surg Forum, 2005, 8(1):E25-E27.
13.	Grossi EA, Loulmet DF, Schwartz CF, et al. Minimally invasive valve surgery with antegrade perfusion strategy is not associated with increased neurologic complications. Ann Thorac Surg, 2011, 92(4):1346-1349.
14.	Pastor MC, Sanchez MJ, Casas MA, et al. Thoracic epidural analgesia in coronary artery bypass graft surgery:seven years' experience. J Cardiothorac Vasc Anesth, 2003, 17(2):154-159.
15.	Ho AM, Chung DC, Joynt GM. Neuraxial blockade and hematoma in cardiac surgery:estimating the risk of a rare adverse event that has not(yet) occurred. Chest, 2000, 117(2):551-555.

1. ?Chitwood WR Jr, Elbeery JR, Chapman WH, et al. Video-assisted minimally invasive mitral valve surgery:the "micro-mitral" operation. J Thorac Cardiovasc Surg, 1997, 113(2):413-414.
2. Modi P, Hassan A, Chitwood WR Jr. Minimally invasive mitral valve surgery:a systematic review and meta-analysis. Eur J Cardiothorac Surg, 2008, 34(5):943-952.
3. Maisano F, La Canna G, Colombo A, et al. The evolution from surgery to percutaneous mitral valve interventions:the role of the edge-to-edge technique. J Am Coll Cardiol, 2011, 58(21):2174-2182.
4. Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(3):797-802.
5. 周和平, 孫國成, 陳濤, 等. 全胸腔鏡下二尖瓣置換的體外循環管理. 中國體外循環雜志, 2011, 9(4):209-210.
6. 程云閣, 王躍軍, 顧劍民, 等. 全胸腔鏡下二尖瓣置換術的臨床經驗總結. 嶺南心血管病雜志, 2007, 13(5):321-323.
7. Sostaric M, Gersak B, Novak-Jankovic V. Early extubation and fasttrack anesthetic technique for endoscopic cardiac surgery. Heart Surg Forum, 2010, 13(3):E190-E194.
8. 韋華, 鄧勁松, 李家勝, 等. 電視胸腔鏡下二尖瓣置換術麻醉期呼吸管理. 中國廠礦醫學, 2008, 21(5):535-536.
9. 陳健, 戴雙波. 電視胸腔鏡二尖瓣置換術93 例麻醉體會. 福建醫藥雜志, 2012, 34(4):126-128.
10. Kiaii B, Bainbridge D, Fernandes P. Surgical, anesthetic, perfusionrelated advances in minimal access surgery. Semin Cardiothorac Vasc Anesth, 2007, 11(4):282-287.
11. Onnasch JF, Schneider F, Falk V, et al. Five years of less invasive mitral valve surgery:from experimental to routine approach. Heart Surg Forum, 2002, 5(2):132-135.
12. Savini C, Camurri N, Castelli A, et al. Myocardial protection using HTK solution in minimally invasive mitral valve surgery. Heart Surg Forum, 2005, 8(1):E25-E27.
13. Grossi EA, Loulmet DF, Schwartz CF, et al. Minimally invasive valve surgery with antegrade perfusion strategy is not associated with increased neurologic complications. Ann Thorac Surg, 2011, 92(4):1346-1349.
14. Pastor MC, Sanchez MJ, Casas MA, et al. Thoracic epidural analgesia in coronary artery bypass graft surgery:seven years' experience. J Cardiothorac Vasc Anesth, 2003, 17(2):154-159.
15. Ho AM, Chung DC, Joynt GM. Neuraxial blockade and hematoma in cardiac surgery:estimating the risk of a rare adverse event that has not(yet) occurred. Chest, 2000, 117(2):551-555.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

全胸腔鏡下二尖瓣置換術麻醉體會

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