Anesthetic Treatment of Radiofrequency Maze Procedure during Valve Replacement_West China Medical Journal

Authors：

HUANG Jianxin , WANG Yu , LAN Zhixun , et al.

Department of Anesthesiology, Sichuan Provincial People’s Hospital, Chengdu 610072, China;

Corresponding?author：

Keywords：

瓣膜置換術; 改良迷宮術; 麻醉處理

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目的:本文回顧性分析總結32例心臟瓣膜置換術同期改良迷宮術患者的麻醉處理。方法:32例瓣膜病合并心房顫動患者,ASA分級Ⅱ-Ⅳ級,心功能ⅢⅣ級,采用以芬太尼為主的全身麻醉,術中以硫酸鎂和艾司洛爾調控應激反應,復溫后多聯合使用多巴胺或(和)多巴酚丁胺5～10μg/kg·min、硝酸甘油或硝普鈉0. 5～5μg/kg·min等血管活性藥物以達到擴張血管增強心肌收縮力、降低心臟負荷、維持循環穩定的目的。停機后預防性安置心外膜起搏導線,使用異丙腎上腺素后心率仍慢者,及時運用臨時起搏,保證有效的心肌收縮和穩定的心率。結果:射頻消融時間為32±5分鐘,主動脈阻斷時間89±12分鐘; 體外循環時間109±20分鐘。心臟自動復跳29例, 電除顫復跳3例, 32例患者術后均為竇性心律。5例患者使用臨時起搏器。結論:完善的術前準備和圍術期重視心肺功能的支持治療, 合理調控應激反應等措施是手術成功的重要基礎。

Citation： HUANG Jianxin,WANG Yu,LAN Zhixun,et al.. Anesthetic Treatment of Radiofrequency Maze Procedure during Valve Replacement. West China Medical Journal, 2009, 24(7): 1690-1692. doi: Copy

1.	ABREU F ILHO C A, L ISBOA L A, DALLAN L A, et al. Effectiveness of the maze procedure using cooledtip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease[J]. Circulation, 2005, 112 (9 Supp l):120-125.
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5.	ATLEE J L, 3RD, BOSNJAK Z J. Mechanisms for cardiac dysrhythmias during anesthesia[J].Anesthesiology,1990,72:347-374.
6.	LINDEBURG T, SPOTOFT H, BREDGAARD SORENSEN M, et al. Cardiovascular effects of etomidate used for induction and in combination with fentanylpancuronium for maintenance of anesthesia in patients with valvular heart disease[J]. Acta Anaesthesiol Scand, 1982,26:205-208.
7.	賈秀紅.鎂缺乏與心力衰竭[J].國外醫學兒科學分冊,1993,20(6):297-300.
8.	金惠銘.病理生理學[M].第五版.北京:人民衛生出版社,2000:41-45,108-110.
9.	MAYSON S E, GREENSPON A J, ADAMS S,et al. The changing face of postoperative atrial fibrillation prevention:a review of current medical therapy[J]. Cardiol Rev, 2007,15(5):231-41.
10.	陳忠堂. 圍術期的心肌保護[J]. 國外醫學麻醉學與復蘇分冊, 1985, 6:173.

1. ABREU F ILHO C A, L ISBOA L A, DALLAN L A, et al. Effectiveness of the maze procedure using cooledtip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease[J]. Circulation, 2005, 112 (9 Supp l):120-125.
2. 湯服民,劉聰霞,吳鐵軍. 射頻消融術治療風心病瓣膜置換術中心房纖顫[J]. 實用醫藥雜志,2008,25 (6):681-682.
3. 吳清玉主編. 心臟外科學[M]. 濟南:山東科學技術出版社,2003:143.
4. 胡小琴主編. 心血管麻醉及體外循環[M]. 北京:人民衛生出版社, 1999:716.
5. ATLEE J L, 3RD, BOSNJAK Z J. Mechanisms for cardiac dysrhythmias during anesthesia[J].Anesthesiology,1990,72:347-374.
6. LINDEBURG T, SPOTOFT H, BREDGAARD SORENSEN M, et al. Cardiovascular effects of etomidate used for induction and in combination with fentanylpancuronium for maintenance of anesthesia in patients with valvular heart disease[J]. Acta Anaesthesiol Scand, 1982,26:205-208.
7. 賈秀紅.鎂缺乏與心力衰竭[J].國外醫學兒科學分冊,1993,20(6):297-300.
8. 金惠銘.病理生理學[M].第五版.北京:人民衛生出版社,2000:41-45,108-110.
9. MAYSON S E, GREENSPON A J, ADAMS S,et al. The changing face of postoperative atrial fibrillation prevention:a review of current medical therapy[J]. Cardiol Rev, 2007,15(5):231-41.
10. 陳忠堂. 圍術期的心肌保護[J]. 國外醫學麻醉學與復蘇分冊, 1985, 6:173.

West China Medical Journal

Anesthetic Treatment of Radiofrequency Maze Procedure during Valve Replacement

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