Objective To investigate the anesthesia management of patients with obstructed total anomalous pulmonary venous connection (TAPVC). Methods Twenty five infants with obstructed TAPVC (age,20 days-3 months;weight,2. 5-4. 6 kg) received drainage operations. Tra-cheal intubation was performed before operation and dopamine and /or milrinone were given. Anesthesia was induced with midazolam, sulfentanil and vecuronium and maintained with sulfentanil, vecuronium and sevoflurance. Routinely, arterial and venous punctures were carried out. Two dual-chamber catheters were inserted into the right jugular vein. One was placed in the central vein, and another was placed across the atrial septum into the left atrium. Vasoactive drugs were administered after opening of arteria aorta to maintain hemodynamic stability. Vasodilator drugs were given through the central vein and vasoconstrictor drugs (catecholamines) through the left atrium cannula. Results Perioperative anesthesia was successful in all infants. Cardiopulmonary bypass time, aortic clamping time and deep hypothermic circulatory arrest time (18 cases) were (114. 6 ± 40. 3),(65. 2 ± 28. 4) and (28. 6 ± 9. 8) minutes,respectively. The positive inotropic drug score was 19. 8 ± 5. 6. There were 2 early operative deaths due to low cardiac output syndrome,including 1 case of supracardiac type and 1 case of mixed type. Conclusion positive preoperative preparation,rational ventilation strategy, maintenance of hemodynamic stability and appropriate administration route are the key factors in infants undergoing drainage operation for obstructed TAPVC.%目的 探讨梗阻型完全性肺静脉异位引流手术的麻醉处理效果.方法 选择梗阻型完全性肺静脉异位引流患儿25例,年龄20 d～3个月,体质量2.5～4.6 kg.术前均行气管插管,泵入多巴胺和(或)米力农等血管活性药.以咪唑安定、舒芬太尼、维库溴铵进行麻醉诱导,视情况调节通气,术中泵注舒芬太尼、维库溴铵并复合吸入七氟烷维持麻醉.常规行动静脉穿刺,其中右侧颈内静脉置入2根4F的双腔静脉导管,1根留置为中心静脉,另1根跨房间隔置入左房留置为左房管.主动脉开放后,泵入血管活性药维持血流动力学平稳,其中扩血管的药物经中心静脉途径,儿茶酚胺类强心缩血管的药物经左房管泵入.结果 全组患儿围术期麻醉平稳顺利.体外循环时间(114.6±40.3)min,主动脉阻断时间(65.2±28.4)min.18例深低温停循环时间为(28.6±9.8)min,正性肌力药物评分(inotropic score)为(19.8±5.6)分;术后早期死亡2例,其中1例为混合型,1例为心上型,原因均为低心排出量综合征.结论 积极的术前准备、合理的通气策略、维持循环稳定及恰当的用药途径是梗阻型完全性肺静脉异位引流患儿安全渡过围术期的关键.
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