CAJ | 학술논문

目的：探讨80例序贯式双肺移植的麻醉管理和注意事项。方法选择接受序贯式双肺移植患者80例,全麻诱导后插入左双腔支气管导管,通气方式采用压力控制模式,麻醉维持采用泵注丙泊酚和顺苯磺酸阿曲库铵,间断静注舒芬太尼镇痛。诱导完成后经右颈内静脉置入Swan-Gans导管,左股动脉置入脉搏指示连续心排量( PICCO)导管监测心排量和外周血管阻力等指标。结果80例序贯式双肺移植的手术时间平均为453．1±83．5 min,术中出血量为2021．3±1235．7 ml。37例双肺移植在体外膜肺( ECMO)辅助氧合下完成,有8例患者术后需ECMO辅助氧合,其余患者均在双肺移植完成后撤除ECMO。在非ECMO辅助氧合的移植患者中,有23例在行首侧肺移植过程中发生氧饱和下降,经阻断肺动脉后好转。所有移植病例在肺移植完成后肺动脉压力明显下降。结论序贯式双肺移植的麻醉管理在于术前对患者病情的正确评估,术中应对循环、呼吸以及内环境进行全方位的监测与精细化处理。
목적：탐토80례서관식쌍폐이식적마취관리화주의사항。방법선택접수서관식쌍폐이식환자80례,전마유도후삽입좌쌍강지기관도관,통기방식채용압력공제모식,마취유지채용빙주병박분화순분광산아곡고안,간단정주서분태니진통。유도완성후경우경내정맥치입Swan-Gans도관,좌고동맥치입맥박지시련속심배량( PICCO)도관감측심배량화외주혈관조력등지표。결과80례서관식쌍폐이식적수술시간평균위453．1±83．5 min,술중출혈량위2021．3±1235．7 ml。37례쌍폐이식재체외막폐( ECMO)보조양합하완성,유8례환자술후수ECMO보조양합,기여환자균재쌍폐이식완성후철제ECMO。재비ECMO보조양합적이식환자중,유23례재행수측폐이식과정중발생양포화하강,경조단폐동맥후호전。소유이식병례재폐이식완성후폐동맥압력명현하강。결론서관식쌍폐이식적마취관리재우술전대환자병정적정학평고,술중응대순배、호흡이급내배경진행전방위적감측여정세화처리。
Objective To explore the anesthetic management of 80 cases of bilateral sequential lung trans-plantation. Methods The study selected 80 patients received sequential bilateral lung transplantation. Left-sided double-lumen tube was inserted and mechanical ventilation was given in PCV mode after induction of general anesthe-sia. Anesthesia was maintained by pumping propofol, cisatracurium besilate and sufentanil. Swan-Gans catheter was inserted in the right internal jugular vein and PICCO catheter was inserted in the left femoral artery to monitor cardiac output and peripheral vascular resistance index. Results The mean operative time of 80 sequential bilateral lung transplantation was 453. 1 ± 83. 5min, and blood loss was 2021. 3 ± 1235. 7ml. 37 cases were under extracorporeal membrane oxygenation ( ECMO) assist for surgery, and 8 of them needed ECMO assist after surgery. In the cases with-out ECMO assist, 23 occurred oxygen saturation decreased during the first side lung transplant, and it was improved when pulmonary artery was blocked. Pulmonary artery pressure decreased significantly after surgery. Conclusion Suc-cessful anesthesia management for bilateral sequential lung transplantation is related with correct preoperative assess-ment, the universal monitor and treatment of circulatory, respiratory, and internal environment during surgery.