摘要：
Objective To summarize the anesthesia management and surgical characteristic of modified extended Morrow procedure in treating hypertrophic obstructive cardiomyopathy (HOCM). Methods This retrospective study was conducted in 139 patients (male 83 and female 56)aged from 1 1 to 66 years.They underwent general anesthesia by high dose intravenous fentanyl or sufentanyl combined with propofol infusion and low concentration sevoflurane inhalation.The surgeons chose ap-propriate surgical procedures,including modified extended Morrow procedure,or combined with mi-tral valve repair (replacement)and coronary artery bypass grafting,etc.All patients received intraop-erative transesophageal echocardiography (TEE ) or epicardial echocardiography monitoring. Results There was no death case in hospital.All patients were hemodynamically stable and there were no malignant adverse events such as ventricular fibrillation during perioperative period.70 (50.4%)of patients automatically recovered to cardiac rhythm after aortic unclamping,and 1 1 (7.9%)of patients needed temporary pacemaker due to atrioventricular block.Cardiopulmonary by-pass (CPB)were weaned off successfully without positive inotropic drugs in 103(74.1%)of patients, while others 36(25.9%)needed low dose dopamine,epinephrine or norepinephrine to maintain hemo-dynamics stable.The CPB time was (142 ± 5 1 )min and the time of aortic clamping was (96 ± 37 ) min.Blood protection was used in all patients and 129 (92.8%)of the patients didn’t receive any blood product.Conclusion Modified extended Morrow procedure was a safe and effective surgical pro-cedure for treatment of HOCM.Experienced teamwork was essential to achieve satisfactory clinical results.The key points of anesthesia management were administration of appropriate preoperative drugs,maintaining adequate anesthesia depth,appropriate preload and afterload,heart rate and rhythm.Intraoperative TEE monitoring was the golden standard for guiding and evaluating the effec-tiveness of the surgical procedures.Meanwhile protection of myocardium,lung,brain and blood can help to obtain satisfactory clinical outcomes.%目的：总结近年来阜外医院改良扩大 Morrow 手术的麻醉处理经验和手术特点。方法139例肥厚性梗阻型心肌病(HOCM)患者,男83例,女56例,年龄11~66岁。均根据患者不同病情特征,采取相应的外科处理[改良扩大 Morrow、改良扩大 Morrow 加二尖瓣成形(置换)或冠状动脉旁路移植等不同手术处理]。在静脉大剂量芬太尼或舒芬太尼复合丙泊酚持续输注、辅助低浓度七氟醚吸入全麻体外循环下手术。所有患者术中均行食管超声心动图(TEE)或经心表超声心动图监测。结果全组无住院死亡。围术期血流动力学平稳,无室颤等恶性不良事件发生。主动脉开放后心脏自动复跳率70例(50.4%),11例(7.9%)因暂时性房室传导阻滞需要使用临时起搏器。复跳后103例(74.1%)患者不需要使用正性肌力药物就可以顺利脱离心肺转流(CPB),其余36例(25.9%)的患者需要中小剂量多巴胺辅助或同时加用肾上腺素或去甲肾上腺素。体外循环时间(142±51)min,主动脉阻断时间(96±37)min。所有患者均采取血液保护措施,术中129例(92.8%)患者未输入血液制品。结论改良扩大 Morrow 是治疗 HOCM 的安全有效术式,要取得满意的临床效果,需要有经验的团队密切协作。麻醉处理也有其特殊性,有效的术前药物治疗,合适的麻醉深度,足够的前、后负荷,控制心率(律)等是麻醉处理的关键。TEE 监测是术中指导和评价手术效果的金标准。同时加强心、肺、脑和血液保护,可以取得满意的临床转归。
