特发性肺动脉高压患者行双肺移植的围麻醉期管理

发布时间：2018-04-29 19:18

本文选题：肺动脉高压 + 双肺移植　；参考：《临床麻醉学杂志》2017年08期

【摘要】：目的探讨治疗特发性肺动脉高压(idiopathic pulmonary arterial hypertension,IPAH)患者行双肺移植术的围麻醉期管理的要点。方法回顾性分析20例接受双肺移植治疗的重症IPAH患者的临床资料,男2例,女18例,ASAⅢ或Ⅳ级。观察麻醉后双肺通气30min、体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)转流后15min、单肺通气、肺动脉阻断30min、肺动脉开放和手术结束各时点血流动力学变化以及手术前后心超检查心血管形态学的改变。结果与麻醉后双肺通气30min比较,ECMO转流后15min时PaO_2、每搏输出量变异度(SVV)明显升高,肺动脉压(PAP)、肺动脉楔压(PAWP)和PaCO_2明显降低(P0.05)。与ECMO转流后15min比较,单肺通气时PAP、PAWP明显升高,SVV明显降低(P0.05);与肺动脉阻断30 min比较,肺动脉开放时SVV明显升高,PAP、PAWP明显降低(P0.05)。4例术毕即刻撤除ECMO,余16例辅助带入ICU。3例术后第1天行开胸探查止血术;13例术后发生不同程度左心功能不全,其中4例出现急性左心衰竭后,2例给予右股静脉-右股动脉(V-A)ECMO转流,2例给予右股静脉-右颈内静脉(V-V)ECMO转流。术后仅3例分别于第5、第6和第13天行气管切开。所有患者均治愈出院,心血管形态学均得到改善。结论积极改善围术期心功能、麻醉诱导和术中血流动力学的平稳、ECMO的合理应用和术后的过渡辅助是IPAH患者手术成功的关键。
[Abstract]:Objective to explore the key points of perioperative management of double lung transplantation for patients with idiopathic pulmonary arterial hypertension (IPAH). Methods the clinical data of 20 cases of severe IPAH patients treated with double lung transplantation were retrospectively analyzed, including 2 men, 18 women, ASA III or IV. The observation of two lung ventilation 30min after anesthesia was observed. After cardiopulmonary oxygenation (extracorporeal membrane oxygenation, ECMO), 15min, single lung ventilation, pulmonary artery occlusion, 30min, pulmonary artery opening and operation at all time points hemodynamic changes and cardiac ultrastructural changes before and after operation were examined. Results compared with 30min after anesthesia, 15min PaO_2 after ECMO bypass, 15min PaO_2, ECMO SVV, pulmonary artery pressure (PAP), pulmonary artery wedge pressure (PAWP) and PaCO_2 were significantly decreased (P0.05). Compared with ECMO, PAP, PAWP significantly increased and SVV decreased significantly (P0.05) compared to ECMO bypass, while pulmonary artery occlusion of 30 min was significantly higher than that of pulmonary artery opening. ECMO was removed immediately, and the remaining 16 cases were assisted with ICU.3 after first days. 13 cases had different degrees of left cardiac insufficiency, of which 4 cases had acute left heart failure, 2 cases were given right femoral vein right femoral artery (V-A) ECMO transfer, and 2 cases were given right femoral vein right internal jugular vein (V-V) ECMO transfer. Only 3 cases after operation were respectively in the first place. 5, sixth, and thirteenth days of tracheotomy. All patients were cured and discharged. Cardiovascular morphology improved. Conclusion active improvement of perioperative cardiac function, anesthesia induction and the smooth hemodynamics in the operation, the rational use of ECMO and postoperative transition assistance are the key to the successful operation of IPAH patients.

【作者单位】：南京医科大学附属无锡人民医院麻醉科;南京医科大学附属无锡人民医院移植科;
【基金】：国家“十一五”重大科技支撑计划资助(2008BAI0B05)
【分类号】：R614

【相似文献】