50例全机器人房间隔缺损修补术麻醉方法总结.doc

50例全机器人房间隔缺损修补术麻醉方法总结 　 作者：周琪，王刚，高长青，陈婷婷 【摘要】 目的 总结50例使用da Vinci S型机器人手术系统行不开胸房间隔缺损修补术的麻醉管理方法。 方法 50例房间隔缺损修补手术均在全麻体外循环下由da Vinci S手术系统操作完成。麻醉诱导采用依托咪酯、利多卡因、哌库溴铵及舒芬太尼静脉注射，诱导后插入左侧双腔支气管导管，术中持续监测食道超声、脑电双频指数、血流动力学及动脉血气分析等。结果 所有患者均顺利完成手术，围手术期无死亡病例。转流前，32例（64％）患者在单肺通气后脉搏氧饱合度（SpO2）下降 (94.5％±1.2％)，未做特殊处理；脱机后，有14例（28％）患者SpO2进行性下降，其中9例（18％）在使用气道内持续正压装置（CPAP）后缓解，有5例（10％）需要间断行双肺通气维持呼吸及循环稳定。平均麻醉时间（254.2±37.6） min，体外循环时间（76.5±22.4） min，升主动脉阻断时间（38.4±19.5） min，术后呼吸机辅助时间（3.2±2.5） h，ICU停留时间（1.9±1.3） d，术后平均住院时间（6.2±2.4） d。术中失血量（152.5±66.2） ml，术后引流量（89.6±41.5） ml。结论 全机器人房间隔缺损修补术的麻醉管理复杂，CO2气胸和单肺通气对血流动力学及呼吸功能的影响较大，对麻醉技术是一项新的挑战。 【关键词】 麻醉；心脏手术；机器人；da Vinci S 手术系统；体外循环 Abstract: OBJECTIVE To summerize the anesthesia for the atrial septal defect(ASD) repair with da vinci S system under cardiopulmonary bypass (CPB). METHODS Fifty patients were underwent general anesthesia for the repair of ASD using da vinci S system under CPB. Anesthesia was induced with etomidate, lidocaine, sulfentanyl and pencuronium. A left-sided double-lumen endotracheal tube was positioned to allow single-lung ventilation post induction. Transesophageal echocardiography (TEE), bispectral index (BIS), hemodynamics and blood gas were routinely monitored. RESULTS All patients’ ASD was repaired with da vinci S system, no hospital mortality. Most patients could tolerate single-lung ventilation before CPB, however fourteen patients had hypoxaemia after CPB, who needed to be treated by continuous positive alveolar pressure(CPAP) instrument or double-lungs ventilation. The time of anesthesia was （254.2±37.6） min, aortic cross-clamp was （38.4±19.5）min, CPB was （76.5±22.4） min, tracheal intubation was （3.2±2.5） h, ICU stay was （1.9±1.3） d and post-operative hospital stay was （6.2±2.4） d. The volume of intra operative blood lose was （152.5±66.2） ml, the volume of post operative drainage was （89.6±41.5) ml. CONCLUSION The anesthesia for the repair of ASD with da vinci S system is comlicated because of the extremely instable hemod