mbt batai Heart and lung transplantation in 1 case

2n2sale160ad

Heart and lung transplantation in 1 case of anesthesia

Blood pressure, peripheral pulse oximetry (SPO:) and so on,[link widoczny dla zalogowanych], in the operation under local anesthesia, intravenous puncture manometry, and the establishment of three intravenous access. Pressurized oxygen mask, followed by intravenous Mi yl stability 4IIlg, fentanyl 0.2IIlg, Xianlin 5IIlg,[link widoczny dla zalogowanych], be patient to sleep, after nasal intubation, when vital signs were stable. 1, respectively Li, et al. Heart and lung transplantation anesthesia in 1 case skin incision, sternotomy, before CPB intravenous fentanyl 0.3mg, Xianlin 4mg, every 90min after the start of cardiopulmonary bypass recovery injection of fentanyl 0.2nag, every 45min chase Note Xianlin 4mg, intermittent inhalation of enflurane. 1.2.2 The establishment of cardiopulmonary bypass pump handle 11:00 receptors, the use of imported centrifugal pump,[link widoczny dla zalogowanych], membrane artificial lung, the conventional balance of sodium lactate solution without blood priming. 0.21 hematocrit, serum potassium 0.42mmol / L, blood temperature 19 ℃, mean arterial pressure 6.9kPa, central venous pressure 12.6kPa, mixed venous oxygen saturation 0.81, transfer urine output 0. 21ml / (kg.min). Open aortic 3IrIin20s, cardiac resuscitation automatically. 15:55 when the bypass ends. At this point blood temperature 36.0 ~ C, mean arterial pressure 11.6kPa, venous pressure 14.6kPa, heart rate 102 times per minute. 1.2.3 Heart-lung transplantation after heart-lung transplant after treatment fentanyl anesthesia to 0.3t. tg / (kg.min) continued to pump every 60min intravenous Xianlin 4mg. After heart resuscitation, cardiac care through continuous infusion 0.5t. tg / (kg.min),[link widoczny dla zalogowanych], nitroglycerin 0.5g, (kg.min), dopamine, dobutamine 5g, (kg.min), epinephrine 0.03t-g / (kg.min), and immunosuppressant K506 and vasodilators prostaglandin E. . 1 every 10min suction to maintain airway pressure <176.4Pa, 20 times per minute, respiratory rate, inspiratory to expiratory ratio of 1:2. 18:50 when the patient awake, carrying the endotracheal tube into the intensive care unit. 1.3 Results anesthesia time 595min, operation time 500min, CPB time 295min, aortic clamping time 220min, warm ischemia time 197s, cold ischemia time 108min. 200s after the aortic automatically open heart resuscitation, sinus rhythm, 105 times per minute, occasional ventricular premature myocardial ruddy, strong contraction, stop after CPB, in the adrenaline, dopamine, nitroglycerin and other drugs, the blood pressure (16 .013.0/10.6-8.0) kPa. Urine satisfaction. SPO was 0.70 before surgery, after induction of anesthesia and 0.91 SPO, during and after cardiopulmonary bypass cardiopulmonary bypass were 0.96-0.99. In addition to tracheal catheter allocated SPO, is 0.94-0.99. Partially awakened after 20min, postoperative mechanical ventilation 3720min, 4320min allocated endotracheal tube. Died of other complications after 45d. 2 to discuss the treatment of heart and lung transplantation patients with end-stage heart and lung disease, one of the most effective means. Owing to the cardiopulmonary transplant patients have been severely damaged, and its poor compensatory reserve capacity of the technical requirements of anesthesia and cardiopulmonary bypass high. I believe that combined heart and lung transplantation in this case the key to success is the following anesthesia. 2.1 The emphasis on good preparation before surgery preoperative preparation, the surgical success. Should pay attention to good lower pulmonary artery pressure, continuous oxygen, water and salt imbalance to correct, prevent arrhythmia, suppression of the immune response, strict aseptic technique. 2.2 The selection of appropriate depth of anesthesia and cardiopulmonary transplantation must be deep surgical anesthesia analgesia, strong muscle relaxation, light sleep, forgetful. On respiration and circulation function disturbance, immune reactions. I believe that the depth of anesthesia before cardiopulmonary transplantation should be darker, to eliminate the stress response, to prevent pulmonary hypertension caused by pulmonary hypertension crisis. Heart and lung transplant operation after the end of the appropriate reduced light anesthesia to reduce the respiratory and circulatory depression. 2.3 The author argues that good management of heart-lung transplant respiratory airway pressure slightly higher than normal before, respiratory rate slower than normal, than the anti-normal breathing, to increase the functional residual capacity, so that the full diffusion of oxygen to correct hypoxemia. 2.4 stable function of the transplanted heart cycle of the lack of autonomic nervous regulation, difficult to maintain the stability of circular functions, vasoactive substances on the circulation function is particularly important supporting role. Movement should be based on pulse pressure, left atrial pressure, heart rate, changes in urine output to adjust epinephrine, dopamine, dobutamine, nitroprusside, nitroglycerin, prostaglandin E. And other drugs pumped into the dose, so that the body of the loop function to maintain a satisfactory level. (Onyx series of school, Ning)

相关的主题文章：

polo outlet online Director of the National Hospit

herve leger sale Parkinson's disease early diagnos

mbt shoes discount EMR treatment of sessile colore