Zhang Jing, Zhang Jianjian, Yang Liuqing, Hu Dingbao, Wang Shuang, Li Sirui, Tian Yueli, Song Xuemin, Li Xinyi, Zhou Yuan
Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Provincial Engineering Research Center of Minimally Invasive Cardiovascular Surgery, Wuhan, China.
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China.
JACC Case Rep. 2025 Aug 20;30(24):104752. doi: 10.1016/j.jaccas.2025.104752.
Surgical treatment of moyamoya disease combined with coronary heart disease presents unique anesthetic challenges.
A 56-year-old woman underwent combined off-pump coronary artery bypass grafting and extracranial-intracranial arterial bypass surgery. The challenges in this surgery included maintaining cerebral oxygenation (regional cerebral oxygen saturation: >75% of baseline), controlled heart rate (60-70 beats/min), lung-protective ventilation (partial arterial pressure of carbon dioxide: 40-45 mm Hg), and mean arterial pressure >70 mm Hg. The patient experienced 2 intraoperative emergencies: hypotension and cerebral oxygen desaturation. The first episode was caused by cardiac displacement and was managed with fluid resuscitation and norepinephrine. The second episode likely resulted from myocardial ischemia-reperfusion injury and was treated with inotropes and coronary vasodilators.
The key to anesthetic management in combined heart-brain surgery lies in balancing the heart-brain perfusion conflict while integrating cerebral function monitoring and myocardial protection.
烟雾病合并冠心病的外科治疗带来了独特的麻醉挑战。
一名56岁女性接受了非体外循环冠状动脉搭桥术和颅外-颅内动脉搭桥术联合手术。该手术的挑战包括维持脑氧合（局部脑氧饱和度：>基线的75%）、控制心率（60-70次/分钟）、肺保护性通气（动脉血二氧化碳分压：40-45mmHg）以及平均动脉压>70mmHg。患者术中出现2次紧急情况：低血压和脑氧饱和度降低。第一次发作是由心脏移位引起的，通过液体复苏和去甲肾上腺素进行处理。第二次发作可能是由心肌缺血-再灌注损伤导致的，使用了正性肌力药物和冠状动脉血管扩张剂进行治疗。
心脑联合手术麻醉管理的关键在于平衡心脑灌注冲突，同时整合脑功能监测和心肌保护。
