CAJ | 학술논문

本院1996年1月至2009年7月行法洛四联症矫治术患者235例,年龄18～54岁,男性123例,女性112例,年龄18～54岁,Hb 122～263 g/L,SpO2 67%～95%.术中监测有创血压、Ⅴ导联心电图、CVP、SpO2、体温和经食道超声心动图.静脉注射咪达唑仑和/或依托咪酯、芬太尼和哌库溴铵麻醉诱导,气管插管后行机械通气.麻醉维持:吸入异氟烷或七氟烷、间断静脉注射芬太尼和哌库溴铵维持麻醉,轻症患者芬太尼用量为30ug/kg,重症患者芬太尼用量为50ug/kg.CPB结束后,给予相应的循环支持,同时加强血液保护和术后呼吸功能的支持.术中7例患者(2.9%)因缺氧发作需要紧急进行CPB,术后18例患者(7.6%)发生灌注性肺损伤,2例患者(0.9%)围术期行体外膜肺氧合辅助支持,术后3例患者(1.3%)死于严重低心排综合征或灌注性肺损伤.其余患者心功能及临床表现均明显改善.
본원1996년1월지2009년7월행법락사련증교치술환자235례,년령18～54세,남성123례,녀성112례,년령18～54세,Hb 122～263 g/L,SpO2 67%～95%.술중감측유창혈압、Ⅴ도련심전도、CVP、SpO2、체온화경식도초성심동도.정맥주사미체서륜화/혹의탁미지、분태니화고고추안마취유도,기관삽관후행궤계통기.마취유지:흡입이불완혹칠불완、간단정맥주사분태니화고고추안유지마취,경증환자분태니용량위30ug/kg,중증환자분태니용량위50ug/kg.CPB결속후,급여상응적순배지지,동시가강혈액보호화술후호흡공능적지지.술중7례환자(2.9%)인결양발작수요긴급진행CPB,술후18례환자(7.6%)발생관주성폐손상,2례환자(0.9%)위술기행체외막폐양합보조지지,술후3례환자(1.3%)사우엄중저심배종합정혹관주성폐손상.기여환자심공능급림상표현균명현개선.
Two hundred and thirty-five patients of both sexes (123 male,112 female) aged 18-54 yr,weighing 35-62 kg underwent repair of tetralogy of Fallot from January 1996 to July 2009 in Fuwai hospital.Direct BP, ECG,CVP,SpO2,naso-pharyngeal temperature and TEE were continuously monitored during operation.Anesthesia was induced with midazolam and/or etomidate, fentanyl and pipecuronium and maintained with isoflurane/sevoflurane inhalation and intermittent iv boluses of fentanyl and pipecuronium. The total amount of fentanyl administered ranged from 30-50 μg/kg. Cardiac function was supported and hemodynamic stability was maintained with vasoactive and inotropic drugs. Measures were taken to strengthen blood conservation and respiratory function support.Seven patients(2.9%) needed urgent CPB during operation because of serious cyanotic spells. Perfusion-induced lung injury occurred in 18 patients (7.6%). Circulation was assisted by ECMO in 2 patients (0.9%). Three patients (1.3%) died of serious low cardiac output and perfusion-induced lung injury.