CAJ | 학술논문

目的探讨中低温或深低温停循环(DHCA)下手术治疗Stanford A型主动脉夹层患者围手术期麻醉管理经验.方法回顾性分析2008年6月至2011年12月浙江大学附属第一医院心胸外科行Stanford A型主动脉夹层手术治疗77例患者麻醉及围手术期监测治疗情况.结果 51例患者在中低温体外循环下手术,26例在DHCA下进行.手术时间152 ～ 600(292±91) min,体外循环时间38 ～310(128±43)min,心肌血运阻断时间31 ～ 169(87±26)min,26例DHCA患者停循环时间20～113(41±19) min.大部分患者通过SVV(每搏量变异度)进行容量管理,注重血液保护及脑保护.术中死亡5例,术后死亡7例.出院65例患者定期门诊随访,无死亡和需要再次手术病例.结论术中对容量的监测管理及血液保护措施是手术成败的重要因素.神经系统并发症是棘手且重要的问题.
목적 탐토중저온혹심저온정순배(DHCA)하수술치료Stanford A형주동맥협층환자위수술기마취관리경험.방법 회고성분석2008년6월지2011년12월절강대학부속제일의원심흉외과행Stanford A형주동맥협층수술치료77례환자마취급위수술기감측치료정황.결과 51례환자재중저온체외순배하수술,26례재DHCA하진행.수술시간152 ～ 600(292±91) min,체외순배시간38 ～310(128±43)min,심기혈운조단시간31 ～ 169(87±26)min,26례DHCA환자정순배시간20～113(41±19) min.대부분환자통과SVV(매박량변이도)진행용량관리,주중혈액보호급뇌보호.술중사망5례,술후사망7례.출원65례환자정기문진수방,무사망화수요재차수술병례.결론 술중대용량적감측관리급혈액보호조시시수술성패적중요인소.신경계통병발증시극수차중요적문제.
Objective To explore the anesthetic management experiences of patients with Stanford A aortic dissection undergoing surgical treatment through moderate or deep hypothermia circulatory arrest (DHCA).Methods From June 2008 to December 2011,a total of 77 patients undergoing surgical treatment of Stanford A aortic dissection was recruited.Results Cardiopulmonary bypass (CPB) was established under general anesthesia in all patients.The procedures included moderate hypothermia (n =51)and DHCA (n =26).The total surgical duration was 152-600(292 ±91)min,CPB time 38-310(128 ±43) min and aortic cross-clamp time 31-169 (87 ± 26)min.The time of circulatory arrest under deep hypothermia was 20-113 (41 ± 19) min in 26 patients.Among 77 patients,there were 5 intraoperative and 7 postoperative fatalities.The remained 65 patients were discharged postoperatively and received a regular outpatient follow-up.None of them died or required reoperation.Conclusion Surgical treatmcnt is appropriate and efficient for the patients with Stanford A aortic dissection.During surgery,the keys of preventing neurological complications are blood volume monitoring and blood protection.