CAJ | 학술논문

目的探讨非体外循环全胸腹主动脉置换手术的麻醉处理经验.方法选择中国协和医科大学阜外医院血管外科2009年10月至2010年9月非体外循环下全胸腹主动脉置换术患者10例,其中男6例,女4例,慢性Stanford B型主动脉夹层动脉瘤5例,慢性Stanford A型夹层动脉瘤2例(一期已行Bentall加全弓及象鼻手术),马凡综合征合并慢性Stanford B型夹层动脉瘤1例,胸腹主动脉瘤2例.所有病例术中均采用血泵法联合自体血液回收技术.记录手术时间、阻断时间、血制品用量及术后并发症.结果 10例患者平均手术时间(7.4±1.2)h,近端主动脉阻断时间(11.5±3.6) min,肋间动脉重建时间(16.4±5.5) min,腹主动脉阻断时间(23.4 ±4.3)min,术后清醒拔除气管插管时间(14.1±2.5)h,血制品用量:血浆(600.5±542.8)ml,血小板(1.7±0.8)治疗量,红细胞(4.3±2.4)U,自体血(465.7±242.3)ml,术后肺不张3例,腹腔积液1例,10例患者均痊愈出院.结论非体外循环下行全胸腹主动脉置换术,减少了深低温停循环对机体的影响和血制品用量,有利于术后恢复.
목적 탐토비체외순배전흉복주동맥치환수술적마취처리경험.방법 선택중국협화의과대학부외의원혈관외과2009년10월지2010년9월비체외순배하전흉복주동맥치환술환자10례,기중남6례,녀4례,만성Stanford B형주동맥협층동맥류5례,만성Stanford A형협층동맥류2례(일기이행Bentall가전궁급상비수술),마범종합정합병만성Stanford B형협층동맥류1례,흉복주동맥류2례.소유병례술중균채용혈빙법연합자체혈액회수기술.기록수술시간、조단시간、혈제품용량급술후병발증.결과 10례환자평균수술시간(7.4±1.2)h,근단주동맥조단시간(11.5±3.6) min,륵간동맥중건시간(16.4±5.5) min,복주동맥조단시간(23.4 ±4.3)min,술후청성발제기관삽관시간(14.1±2.5)h,혈제품용량:혈장(600.5±542.8)ml,혈소판(1.7±0.8)치료량,홍세포(4.3±2.4)U,자체혈(465.7±242.3)ml,술후폐불장3례,복강적액1례,10례환자균전유출원.결론 비체외순배하행전흉복주동맥치환술,감소료심저온정순배대궤체적영향화혈제품용량,유리우술후회복.
Objective To summarize the experience in anesthetic management for total thoracoabdominal aorta replacement without cardiopulmonary bypass.Methods From October 2009 to September 2010,10 patients of Fuwai Hospital received off-pump total thoracoabdominal aorta replacement.Of these patients,5 were subjected to Standford B aortic dissection,2 were Standford A aortic dissection received total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta.1 were Marfan's syndrome,and 2 were thoracoabdominal aorta.All operations used the technique which preserved blood was transfused back by pump via the femoral artery.Results The average surgery time was (7.4 ± 1.2) h and extubation time was (14.1 ± 2.5) h,the descending thoracic aorta crossclamp time was (11.5 ± 3.6) min,the intercostal artery reconstruction time was (16.4 ± 5.5) min,the required amount of blood products was fresh frozen plasma(600.5 ±-542.8) ml,platelet(1.7 ± 0.8) U,red blood cell(4.3 ± 2.4) U,autoblood salvage(465.7 ± 242.3) ml.Three patients occured atelectasis and one patient occurred seroperitoneum postoperation.All of the 10 patients were discharged from hospital without any neurologic complications.Conclusion The anesthetic management for total thoracoabdominal aortareplacement without cardiopulmonary bypass is feasible.It can reduce the side effects of deep hypothermia circulatory arrest and had a good effect.