安置永久起搏器患者心脏手术中的麻醉管理_临床医学论文.docVIP

安置永久起搏器患者心脏手术中的麻醉管理_临床医学论文 安置永久起搏器患者心脏手术中的麻醉管理_临床医学论文 作者：王刚，周琪，陈婷婷，高长青，李佳春 【摘要】 目的对安置起搏器的患者在心脏手术中的风险因素和处理进行探讨。方法近两年有7例安置起搏器的患者接受心脏手术和麻醉。起搏器类型包括6例DDD和1例AAI。所患心脏疾病：6例为冠心病和病窦综合症；1例为完全性房室传导阻滞。麻醉诱导采用芬太尼、咪唑安定和维库溴胺。术中均使用单极电烙。结果7例患者均未对起搏器使用磁铁。术中虽然将电烙输出能量降低，并应用短脉冲放电，但电烙仍成为对起搏器的最大干扰。1例患者术后起搏器失灵，考虑是起搏器导线移位所致。手术过程顺利，所有患者术毕均安置心外膜临时起搏器。结论详细了解手术中起搏器易损因素和相关并发症的知识，并采取正确的管理措施对保证安置起搏器患者在心脏手术中的安全有重要意义。 【关键词】 心脏手术；起搏器；麻醉；电磁干扰 　　Intraoperative Management of Patients with Implanted Pacemakers for Cardiac Surgery 　　Abstract: OBJECTIVE To evaluate the intraoperative potential risk factors and management strategies for the patients with implanted pacemakers in cardiac surgery. METHODSFor last two years 7 patients of cardiac surgery with implanted pacemakers submitted: 6 patients with DDD mode and one with AAI mode. Six cases suffered ischemic heart disease and sick sinus syndrome,one case had complete atriovenricular(A-V) block. Anesthesia was induced with fentanyl, midazolam and vecuronium. Unipolar cautery was used during surgery. RESULTSMagnet was not applied. Electrocautery remained the most common intraoperative interference to pacemaker,though power output of electrocautery was kept to a less energy,and using short bursts. One case appeared pacemaker output failure postoperatively,because of the possibility of lead dislodgement. The epicardial temporary pacing was prophylactic placed for every patients. The surgical operation was successfully performed and the operative course was uneventful. CONCLUSIONThese case reports suggest that either appropriate anesthetic management or knowledge of the potential electromagetic interference with pacemakers is required to perform these procedures safely. 　　Key words：Cardiac surgery;Pacemaker;Anesthesia;Electromagnetic interference 　　随着起搏器技术的发展及起搏器临床应用范围和适应证的拓宽，心脏手术患者中携带起搏器者亦愈加常见。此类患者麻醉和手术中需要妥善处理的相关问题已经受到麻醉医生的重视。近两年，在本科完成的上千例心血管手术中，共有7例携带置入式永久起搏器的病例。本文拟就此类患者的麻醉和术中相关的特殊处理进行总结和讨论。 　　1资料和方法 　　1.1一般资料 　　7例患者平均年龄65.8（36～79）岁。安装起搏器的原因包括：病窦综合征6例；Ⅲ度房室传导阻