Department of Anesthesiology, Liaocheng People's Hospital of Shandong University, Liaocheng, China.
Med Princ Pract. 2013;22(3):234-8. doi: 10.1159/000345844. Epub 2012 Dec 29.
This study was designed to assess the factors that influence immediate extubation following totally thoracoscopic closure of congenital heart defects.
Clinical and operational data of 216 patients (87 males, average age 13.6 ± 10.9 years) were retrospectively analyzed. Atrial (ASD, n = 90) or ventricular septal defects (VSD, n = 126) were closed via a totally thoracoscopic approach. Ultra-fast-track anesthesia (UFTA) was used in all patients.
Immediate extubation in the operating room was successfully performed in 156 (72.2%) patients. A delayed extubation was completed in the intensive care unit in the remaining 60 (27.8%) patients. There was no significant difference in the age, sex, body weight, or type of congenital heart defect between the immediate and delayed extubation groups (p > 0.05). However, more patients in the delayed extubation group had severe preoperational pulmonary hypertension [8 (13.3%) vs. 4 (2.3%), p < 0.05]. The cardiopulmonary bypass time, aortic clamp time, and total duration of the surgery in the immediate extubation group were shorter than in the delayed extubation group (p < 0.05). Multivariate logistic regression analysis showed that preoperational pulmonary hypertension, duration of the surgery or cardiopulmonary bypass, and dosage of fentanyl used during the surgery were independent predictors for immediate extubation.
UFTA and immediate extubation in the operating room was feasible and safe in the majority of patients undergoing totally thoracoscopic closure of ASD or VSD. Preoperational pulmonary hypertension, duration of the surgery, and the dosage of fentanyl used for UFTA were the determining factors for immediate extubation.
本研究旨在评估全胸腔镜下心内缺损修补术后即刻拔管的影响因素。
回顾性分析 216 例（男 87 例，平均年龄 13.6±10.9 岁）患者的临床和手术资料。采用全胸腔镜技术关闭房间隔缺损（ASD，n=90）或室间隔缺损（VSD，n=126）。所有患者均采用超快通道麻醉（UFTA）。
156 例（72.2%）患者在手术室成功即刻拔管，60 例（27.8%）患者在重症监护病房延迟拔管。即刻拔管组和延迟拔管组患者的年龄、性别、体重或先天性心脏病类型无显著差异（p＞0.05）。然而，延迟拔管组中更多的患者存在严重的术前肺动脉高压[8（13.3%）比 4（2.3%），p＜0.05]。即刻拔管组的体外循环时间、主动脉阻断时间和手术总时间均短于延迟拔管组（p＜0.05）。多因素逻辑回归分析显示，术前肺动脉高压、手术持续时间或体外循环时间以及术中芬太尼用量是即刻拔管的独立预测因素。
UFTA 和在手术室即刻拔管对于大多数接受全胸腔镜 ASD 或 VSD 修补术的患者是可行且安全的。术前肺动脉高压、手术持续时间和 UFTA 中使用的芬太尼剂量是决定即刻拔管的因素。
