机器人冠脉搭桥手术的麻醉

Investigation of anesthesia for robotic assisted coronary artery bypass grafting

  • 摘要: 目的:对da Vinci机器人冠脉搭桥手术的麻醉要求和管理方法进行探讨。方法:2007年1-9月我院完成机器人冠脉搭桥手术16例,采用全麻双腔支气管插管,在右侧单肺通气和左侧CO2气胸下进行手术,术中常规行经食道超声(TEE)、血流动力学和血气监测。结果:15例患者由机器人辅助完成左乳内动脉游离后,经左侧肋间小切口,直视下完成血管吻合;1例全机器人手术由机器人完成左乳内动脉游离和血管吻合全过程。多数患者能够耐受单肺通气和CO2气胸,但1例全机器人手术中,患者出现低氧和高碳酸血症并引发心动过速。术后拔管时间平均4.72 h,ICU停留时间1.2 d,术后平均住院日6.6 d。术后并发1例房颤和1例肺不张。结论:对于机器人冠脉搭桥手术,麻醉的关键是预防和处理单肺通气和CO2气胸引起的缺氧和血流动力学波动。

     

    Abstract: Objective: Robotic assisted coronary artery bypass grafting(RACAB) surgery is a fast-developing technique with the use of the da Vinci surgical system.The anesthesia for RACAB was investigated which is technically more challenging.Methods: Between January 2007 and September 2007,16 RACAB surgeries on beating heart were performed at our institution with the da Vinci surgical system.With the standard general anesthesia,a double-lumen endotracheal tube was positioned to allow single right-lung ventilation.TEE,hemodynamics and blood gas were routinely monitored.Results: In 15 patients,left internal thoracic artery grafts were harvested with robotic assistance,and anastomoses were manually constructed through a small thoracotomy incision.In one other patient,totally endoscopic coronary artery bypass grafting(TECAB) was performed with the robotic system.Although single-lung ventilation and CO2 pneumothorax were well tolerated in most patients,the sole patient to receive TECAB showed hypoxemia and hypercapnia,as well as a compensatory increase in heart rate.The period from completion of surgery to extubation averaged 4.72 hours.The average length of ICU stay was 1.2 days and post-operative hospital stay was 6.6 days.The complications included 1 patient with atrium fibrillation and 1 patient with atelectasis.Conclusion: The key point of anesthesia for RACAB is to deal with hypoxemia and undulated hemodynamics as a result of single right-lung ventilation and CO2 pneumothorax.

     

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