摘要
目的探讨全胸腹主动脉替换术(tTAAAR)的麻醉管理及术后早期恢复。方法应用我院病案室的病案资料数据库,检索自2009年2月至2012年1月由同一组手术医师施行的tTA-AAR患者61例,比较深低温停循环组(A组,n=19)和常温非体外循环组(B组,n=42)。所有患者均采用了双腔支气管插管、静-吸复合全身麻醉,术中常规应用有创血流动力学监测,采用cellsaver洗涤红细胞量、术中库存红细胞悬液输入量、术中新鲜冰冻血浆输入量,ICU停留时间、早期死亡率、一过性脑功能障碍,脊髓损伤、肾功能衰竭和呼吸系统并发症。结果与A组比较,B组手术时间和ICU停留时间明显缩短(P<0.05或P<0.01),洗涤红细胞量、红细胞悬液输入量和血浆用量明显减少(P<0.05),一过性脑功能障碍明显减轻、术后早期死亡百分比明显降低(P<0.05),脊髓损伤、急性肾功能衰竭和呼吸系统并发症发生率差异均无统计学意义。结论密切监护下的静-吸复合全身麻醉,结合血液保护与神经保护措施,对改善tTAAAR患者术后早期恢复有积极意义。常温非体外循环比深低温停循环对改善术后早期恢复具有明显优势。
Objective To analyze the anesthetic management for total thoracoabdominal aortic aneurysm repair （tTAAAR） and the anesthesia related early postoperative outcome. Methods Data of patients underwent tTAAAR with four branch vessel prosthesis from February 2009 to January 2012 were collected. Anesthesia management and the early postoperative outcome were summarized and compared between patients with or without deep hypothermic circulatory arrest （DHCA）, as patients were divided into two groups： group A under DHCA and group B under normal thermianoncardiopulmonary bypass. Intravenous anesthesia combined with sevoflurane and double lumen bronchial intubation were performed in all patients. Invasive hemodynamic parameters and arterialpressure-based cardiac output （APCO）, were monitored continuously. Tranexamic acid, ulinastatin and edaravone were infused for blood conservation and cerebral function protection. Cell saver were also used generally for every case. Results The durations of operation in group A were significantly longer than those in group B （P〈O. 01）, so were the ICU stay. The volume of blood transfusion during operation in group A was more than that in group B （P〈0.05）, so were the volume of washed red cell blood and fresh frozen plasma transfusion （P〈0. 05）. Early mortality in group A was higher than that in group B （P〈0. 05）, so was early postoperative transient neurological dysfunction （P〈O. 05）. There were no significant differences in spinal cord dysfunction, acute kidney dysfunction and respiratory complications between two groups. Conclusion Intravenous anesthesia combined inhalation with close hemodynamic monitoring, effective blood conservation and brain protection are benefit to early postoperative outcome of patients undergoing tTAAAR. The patients under normal thermianoncardiopulmonary bypass had better early postooerative outcome.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第5期428-431,共4页
Journal of Clinical Anesthesiology
关键词
胸腹主动脉替换
人工血管
麻醉
Thoracoabdominal aortic aneurysm repair Prosthesis vessel
Anesthesia
