左心发育不良综合征患儿行经典 NorwoodⅠ期手术麻醉管理经验总结

摘要

目的：回顾性分析开展NorwoodⅠ期手术的麻醉管理经验。方法2010年6月至2014年8月，我院共为5例罹患左心发育不良综合征的患儿行经典NorwoodⅠ期手术，均为男性，手术时年龄29～75天，中位年龄36天；体质量2.57～3.50 kg，中位体质量3.13 kg。第1、2、3例患儿术前经静脉给予前列腺素E1，呼吸机辅助通气，因血流动力学状态进行性恶化而行抢救性急诊手术；第4、5例患儿术前除必需检查无其他医疗干预，行限时性急诊手术。5例患儿均在静吸复合麻醉下经体外循环行手术，术中利用深低温停循环技术。结果第4例患儿在体外循环结束后因心肌收缩无力死亡。其余4例均顺利撤除体外循环，第3例在术后32 h死亡。结论 Norwood 手术是心脏外科复杂的术式，麻醉管理在整个围手术期管理中的作用举足轻重。%Objective To retrospectively analyse the anaesthetic management of Norwood Stage Ⅰ.Methods Between June 2010 and August 2014, totally 5 small infants with HLHS underwent the standard Norwood Stage I procedure .They were all boys.Age at surgeries ranged from 29 to 75 days with median 36 days, and weight from 2.57 -3.50 kg with median of 3.13kg.The first three cases were received intravenous prostaglandin E1 before they were sent to the operation theatre and were under mechanical ventilation .They were received emergent operations because of unstable hemodynamic situation .The other two cases were relatively stable without mechanical ventilation and were received restrict surgery .All 5 cases received the stand-ard Norwood Stage Ⅰprocedure under intravenous-inhalation balance-general anaesthesia with cardiopulmonary bypass.The technique of deep hypothermia and circulatory arrest were used in all five cases .Results The fourth case died from low cardi-ac output syndrome after cardiopulmonary bypass .The other 4 cases were transferred to the paediatric intensive care unit after withdrawal from bypass.One of the four cases died after 32 h after surgery.Conclusion The standard Norwood Stage Ⅰ pro-cedure is aquite complex procedure, which demands multidisplinary cooperation, to palliatively correct HLHS.We retrospect the experiences of the anesthetic management in our centre and hope it will be helpful to decrease the mortality and morbidity in relatively short period.