全胸腔镜下二尖瓣置换术麻醉体会_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

彭玲 ¹ , 李霞 ¹ , 郭应强 ² ,  魏蔚 ¹

1. ;
2. ;

Corresponding author：

魏蔚, Email: 111weiwei@sohu.com

Keywords：

麻醉; 电视胸腔镜; 二尖瓣置换术

DOI：

10.7507/1007-4848.20150023

Video：

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目的探讨全胸腔镜下二尖瓣置换术的麻醉心得。方法回顾性分析2011年10月至2012年7月四川大学华西医院拟在全胸腔镜下行二尖瓣置换术7例患者的临床资料。男4例、女3例，年龄19～53（34.17±5.58）岁，体重42～69（56.00±3.69）kg。心功能根据纽约心脏协会（NYHA）分级为Ⅱ～Ⅲ级，术前心电图显示均为窦性心律，超声心动图检查提示，以二尖瓣狭窄病变为主3例，以二尖瓣反流病变为主4例。采用双腔气管内插管，静脉吸入复合全身麻醉，麻醉维持以异丙酚4～10 mg（/kg·h）静脉输注，间断给予舒芬太尼和维库溴铵维持镇痛肌松。在食管超声引导下采用右侧股动静脉插管建立体外循环，主动脉阻断后行主动脉根部顺行性灌注心肌保护液。结果 7例患者中有6例在全胸腔镜辅助下顺利完成二尖瓣置换术，1例中转开胸完成二尖瓣置换术。6例行全胸腔镜下二尖瓣置换术患者主动脉阻断时间71～144（112.33±9.90）min，体外循环（CPB）时间97～180（150.33±11.60）min，手术时间200～300（251.67±13.52）min，术后拔管时间8.0～20.5（14.37±2.06）h，住ICU时间42.5～53.2（47.65±1.42）h，住院时间11～16（14.17±0.79）d。术后均无二尖瓣机械瓣瓣周漏，无血肿、感染、肺不张等严重并发症，无死亡。结论对于电视胸腔镜下二尖瓣手术的麻醉，充分的术前评估和麻醉前准备是基础，术中充足的大脑灌注和静脉引流是重点，经食管超声心动图的指导作用是关键。

Citation： 彭玲, 李霞, 郭应强, 魏蔚. 全胸腔镜下二尖瓣置换术麻醉体会. 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.
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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, 孙国成, 陈涛, 等. 全胸腔镜下二尖瓣置换的体外循环管理. 中国体外循环杂志, 2011, 9(4):209-210.
6.	程云阁, 王跃军, 顾剑民, 等. 全胸腔镜下二尖瓣置换术的临床经验总结. 岭南心血管病杂志, 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.	韦华, 邓劲松, 李家胜, 等. 电视胸腔镜下二尖瓣置换术麻醉期呼吸管理. 中国厂矿医学, 2008, 21(5):535-536.
9.	陈健, 戴双波. 电视胸腔镜二尖瓣置换术93 例麻醉体会. 福建医药杂志, 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, 孙国成, 陈涛, 等. 全胸腔镜下二尖瓣置换的体外循环管理. 中国体外循环杂志, 2011, 9(4):209-210.
6. 程云阁, 王跃军, 顾剑民, 等. 全胸腔镜下二尖瓣置换术的临床经验总结. 岭南心血管病杂志, 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. 韦华, 邓劲松, 李家胜, 等. 电视胸腔镜下二尖瓣置换术麻醉期呼吸管理. 中国厂矿医学, 2008, 21(5):535-536.
9. 陈健, 戴双波. 电视胸腔镜二尖瓣置换术93 例麻醉体会. 福建医药杂志, 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

全胸腔镜下二尖瓣置换术麻醉体会

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