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ⅢⅣ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:
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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 cooledtip 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 fentanylpancuronium 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.
