摘要
目的讨论QT间期延长综合征患者经胸腔镜左侧胸交感神经切断术的麻醉处理。方法2011年7月-2014年10月择期行经胸腔镜左侧胸交感神经切断术的患者8例，美国麻醉医师协会分级Ⅱ～Ⅲ级，术前予适量B受体阻滞剂，以咪达唑仑0．1mg／kg、芬太尼3—6μg／kg、丙泊酚2～4mg／kg、顺式阿曲库铵0．3～0．6mg／kg麻醉诱导，以丙泊酚1～4mg／（kg·h）复合瑞芬太尼0．025～2．000μg／（kg·min）维持麻醉。分别于麻醉诱导前（T0）、气管插管时（T1）、人工肺萎陷手术开始（T2）、手术进行后5min（T3）、手术进行后15min（T4）、手术结束人工膨肺（T5）和拔管时（T6）记录平均动脉压（MAP）、心率、脉搏氧饱和度（SpO2）以及气道峰压、呼气末二氧化碳分压（PetCO2）变化情况。结果与T0时比较，T2时MAP升高，T3、T4时心率均减慢（P〈0．05），但均在正常范围内；SpO2在术中各时间点维持趋于平稳；所有患者术中气道峰压、PetCO2均变化不大，差异无统计学意义（P〉0．05）。结论QT间期延长综合征患者经胸腔镜左侧胸交感神经切断术的麻醉处理得当使血流动力学及呼吸功能变化平稳，可减少围手术期恶性心律失常的发生。
Objective To discuss the anesthetic procedure for left thoracic sympathectomy under thoracoscope for long QT syndrome patients. Methods We selected 8 patients with long QT syndrome classified American Society of Anesthesiologists Ⅱ- Ⅲ who were going to undergo left thoracic sympathectomy under thoracoscope between July 2011 and October 2014 as our study subjects. They were given a moderate amount of beta blockers before operation, inducted with 0.1 mg/kg midazolam, 3-6 μg/kg fentanyl, 2-4 mg/kg propofol, 0.3-0.6 mg/kg cis-atracurium, and maintained with propofol 1-4 mg/（kg·h） combined with 0.025-2.000 μg/（kg·min） fentanyl. We recorded the mean arterial pressure（MAP）, heart rate（HR）, pulse oxygen saturation（Sp O2） and airway peak pressure, and end-tidal carbon dioxide before anesthesia induction（T0）, at endotracheal intubation（T1）, during artificial lung-collapse when surgery initiated（T2）, 5 minutes after surgery initiation（T3）, 15 minutes after surgery initiation（T4）, during artificial lung-collapse at the end of surgery（T5） and during extubation（T6）. Results When compared with T0, T2 got a higher MAP, T3 and T4 had a slower HR（P 〈0.05）, but all were within a normal range. All the patients showed little change in airway peak pressure and end-tidal carbon dioxide during the surgery with no statistically significant difference（P 〉 0.05）. Conclusion Proper anesthetic procedure for left thoracic sympathectomy under thoracoscope for long QT syndrome patients can reduce the incidence of perioperative malignant arrhythmia.
出处
《华西医学》
CAS
2016年第2期258-261,共4页
West China Medical Journal
