|
Fifty-eight cases of multiple cardiac valves replacement were performed under intravenous balanced anesthesia. As the main anesthetic agents concerned, 41 oases received intravenous morphine, 12 cases droperidol-fentanyl and 5 cases diazepam-ketamine. All of those, suffered from valvular stenosis, regurgitation or combined, and those, associated with fixed low cardiac output, had their pathophysiology including hemodynamics altered a great deal; therefore the choice of anesthetics and adjuvants should... Fifty-eight cases of multiple cardiac valves replacement were performed under intravenous balanced anesthesia. As the main anesthetic agents concerned, 41 oases received intravenous morphine, 12 cases droperidol-fentanyl and 5 cases diazepam-ketamine. All of those, suffered from valvular stenosis, regurgitation or combined, and those, associated with fixed low cardiac output, had their pathophysiology including hemodynamics altered a great deal; therefore the choice of anesthetics and adjuvants should be seriously considered.During the anesthesia, the use of vasoconstrictors has to be reduced to the least, vasodilators given freely whenever indicated and diuretics cancelled as a routine. For the monitorings and managements of anesthesia, basic principles have to be strictly followed.When the coronary blood-flow was interrupted for less than 90 minutes, 77.1 % of the operated hearts restored their beats spontaneously without electric shock. Nine cases died. Among them, one died during the induction stage and another 12 hours after surgery, both being considered to be due to poor experience. Causes of death for the remaining 7 cases died 4-39 days afterward, have also been analysed with brief discussion. Better post-operative intensive care may further reduce the surgical mortality 58例心脏多瓣膜置换术皆采用复合全麻,有41例以静注吗啡为主,12例芬太尼和氟哌啶为主,5例安定和氯胺酮为主,这三种方法,都应该按照病人的病理生理情况,尤其是瓣膜狭窄、关闭不全或双病变,以及心输出量是否已固定并减少等而定取舍。术中升压药尽可能少用,血管扩张药(降压药)的使用不要延误时间,利尿药(速尿)则不必列为常规。一应有关麻醉的监测和管理,原则上与单瓣膜置换术无异,如能控制冠状血流阻断时间不超过90分钟,心搏自动复跳率可达77.1%。58例中死亡9例:1例死于全麻诱导,1例术后12小时死亡,其余7例分别死于术后4~39天内,原因是多方面的,加强了术后的监护当可再有改善。 In the selection of the best drug for postoperative analgesia, the following drugs were injected respectively into retained continuous epidural block catheter, namely, pethidine 20mg(n=50), morphine 2mg(n=50), phenoperidine 0.2mg(n=25), fentanyl 0.02mg(n=25), fentanyl 0.05mg(n=25), saline 10ml(n=25) and cold saline 10ml(n=25). It was found that the duration of postoperative analgesia, 21.58±3.69 h, of morphine group was the longest, although the onset of analgesia, 7.89±2.21 rain, was slower. The... In the selection of the best drug for postoperative analgesia, the following drugs were injected respectively into retained continuous epidural block catheter, namely, pethidine 20mg(n=50), morphine 2mg(n=50), phenoperidine 0.2mg(n=25), fentanyl 0.02mg(n=25), fentanyl 0.05mg(n=25), saline 10ml(n=25) and cold saline 10ml(n=25). It was found that the duration of postoperative analgesia, 21.58±3.69 h, of morphine group was the longest, although the onset of analgesia, 7.89±2.21 rain, was slower. The BP and pulse rate were not significantly changed, and no complications were encountered except 4 cases with urinary retention. The keys to the successful use of epidural morphine are epidural catheter at appropriate spinal segment, adequate volume(10 ml) of solution injected and adequate dose(2 mg) of morphine used. 连续硬膜外阻滞下手术225例,术后保留导管。在麻醉作用消失后,经导管注入麻醉性镇痛药(吗啡、哌替啶、酚哌啶、芬太尼)或生理盐水(对照组)观察镇痛效果。其中以吗啡组效果最好,镇痛持续时间为21.58±3.69小时,≥24小时者占70%。225例中除发生7例尿潴留、9例恶心及6例呕吐外,无其他不良反应,对血压、呼吸及脉搏均无明显影响。 6 cases of anesthetic management for valve reimplantation were reported.Acute valvular regurgitation occurred promptly after the rupture of heart bioprosthesis,heart failure and pulmonary edema might result.Maintenance of the cardiovascular stability was a matter of great importance before operation.All patients were inducted with sleeping dose of sodium pantothal,and the maintenance of anesthesia was carried out with fentanyl combining with N2O-O2 and pancuronium,except one case in which intravenous morphine... 6 cases of anesthetic management for valve reimplantation were reported.Acute valvular regurgitation occurred promptly after the rupture of heart bioprosthesis,heart failure and pulmonary edema might result.Maintenance of the cardiovascular stability was a matter of great importance before operation.All patients were inducted with sleeping dose of sodium pantothal,and the maintenance of anesthesia was carried out with fentanyl combining with N2O-O2 and pancuronium,except one case in which intravenous morphine was employed.The cardiovascular function was stable during operation,and no event was encountered.We believed that the balance anesthesia was the best choice in those patients.Principles of administration were recommanded as follows small dose and lower concentration.Any cardiac depression must be avoided,and patients could go well till the bypass. 本文报道6例再次瓣膜置换术的麻醉处理。这类病人瓣膜破裂后,出现急性瓣膜反流,造成心力衰竭和肺水肿,术前应维持循环功能稳定。麻醉诱导采用睡眠剂量的硫喷妥钠,麻醉的维持除1例应用吗啡麻醉外,其余均用芬太尼辅以N_2O-O_2配合潘侃朗宁,结果术中循环稳定,未发生意外。作者认为:此类病人麻醉的选择,应以复合麻醉为宜,麻醉药的使用应根据小剂量低浓度的原则,避免心肌抑制,使病人顺利过渡到体外循环。
|