Anesthetic Treatment of Radiofrequency Maze Procedure during Valve Replacement_West China Medical Journal

Authors：

HUANG Jianxin , WANG Yu , LAN Zhixun , et al.

Department of Anesthesiology, Sichuan Provincial People’s Hospital, Chengdu 610072, China;

Corresponding author：

Keywords：

瓣膜置换术; 改良迷宫术; 麻醉处理

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目的:本文回顾性分析总结32例心脏瓣膜置换术同期改良迷宫术患者的麻醉处理。方法:32例瓣膜病合并心房颤动患者,ASA分级Ⅱ-Ⅳ级,心功能ⅢⅣ级,采用以芬太尼为主的全身麻醉,术中以硫酸镁和艾司洛尔调控应激反应,复温后多联合使用多巴胺或(和)多巴酚丁胺5～10μg/kg·min、硝酸甘油或硝普钠0. 5～5μg/kg·min等血管活性药物以达到扩张血管增强心肌收缩力、降低心脏负荷、维持循环稳定的目的。停机后预防性安置心外膜起搏导线,使用异丙肾上腺素后心率仍慢者,及时运用临时起搏,保证有效的心肌收缩和稳定的心率。结果:射频消融时间为32±5分钟,主动脉阻断时间89±12分钟; 体外循环时间109±20分钟。心脏自动复跳29例, 电除颤复跳3例, 32例患者术后均为窦性心律。5例患者使用临时起搏器。结论:完善的术前准备和围术期重视心肺功能的支持治疗, 合理调控应激反应等措施是手术成功的重要基础。

Citation： HUANG Jianxin,WANG Yu,LAN Zhixun,et al.. Anesthetic Treatment of Radiofrequency Maze Procedure during Valve Replacement. West China Medical Journal, 2009, 24(7): 1690-1692. doi: Copy

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1. ABREU F ILHO C A, L ISBOA L A, DALLAN L A, et al. Effectiveness of the maze procedure using cooledtip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease[J]. Circulation, 2005, 112 (9 Supp l):120-125.
2. 汤服民,刘聪霞,吴铁军. 射频消融术治疗风心病瓣膜置换术中心房纤颤[J]. 实用医药杂志,2008,25 (6):681-682.
3. 吴清玉主编. 心脏外科学[M]. 济南:山东科学技术出版社,2003:143.
4. 胡小琴主编. 心血管麻醉及体外循环[M]. 北京:人民卫生出版社, 1999:716.
5. ATLEE J L, 3RD, BOSNJAK Z J. Mechanisms for cardiac dysrhythmias during anesthesia[J].Anesthesiology,1990,72:347-374.
6. LINDEBURG T, SPOTOFT H, BREDGAARD SORENSEN M, et al. Cardiovascular effects of etomidate used for induction and in combination with fentanylpancuronium for maintenance of anesthesia in patients with valvular heart disease[J]. Acta Anaesthesiol Scand, 1982,26:205-208.
7. 贾秀红.镁缺乏与心力衰竭[J].国外医学儿科学分册,1993,20(6):297-300.
8. 金惠铭.病理生理学[M].第五版.北京:人民卫生出版社,2000:41-45,108-110.
9. MAYSON S E, GREENSPON A J, ADAMS S,et al. The changing face of postoperative atrial fibrillation prevention:a review of current medical therapy[J]. Cardiol Rev, 2007,15(5):231-41.
10. 陈忠堂. 围术期的心肌保护[J]. 国外医学麻醉学与复苏分册, 1985, 6:173.

West China Medical Journal

Anesthetic Treatment of Radiofrequency Maze Procedure during Valve Replacement

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