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目的探讨犬肺移植外科手术的麻醉管理,为临床人体肺移植手术做准备。方法本组共完成16例犬肺移植麻醉,其中11例为自体肺移植,5例同种异体肺移植。供肺冷缺血时间为2~22 h。手术在气管插管全凭静脉全麻下完成,股动脉穿刺置管有创动脉监测血压,连续SpO2监测,定时抽动脉血行血气分析。分析调整呼吸参数,根据循环情况用血管活性药物。结果11例犬术毕麻醉苏醒,气管导管顺利拔出,能站立行走并存活4~72 h,有4例犬移植肺动脉开放后,1例犬麻醉苏醒拔出气管导管后发生急性肺水肿,体循环衰竭而死亡。犬肺移植后供肺早期换气功能良好。结论肺移植缺血再灌注损伤是早期发生肺功能损伤和急性肺水肿主要原因,经体液治疗,提高胶体渗透压,呼吸道的管理、血管活性药物的应用等措施可减少或延缓肺功能损伤和急性肺水肿的发生,以保证供肺换气功能。
Objective To investigate the anesthesia management of canine lung transplantation surgery in preparation for clinical human lung transplantation. Methods The group completed a total of 16 cases of canine lung transplantation anesthesia, of which 11 cases of autologous lung transplantation, 5 cases of allograft lung transplantation. Lung ischemia for 2 ~ 22 h. Surgery in the complete endotracheal intubation complete with intravenous anesthesia, femoral artery puncture catheter invasive arterial blood pressure monitoring, continuous SpO2 monitoring, regular blood gas pulse twitch line analysis. Analysis and adjustment of respiratory parameters, according to the circulation of vasoactive drugs. Results A total of 11 dogs were anesthetized and awakened. Tracheal catheter was withdrawn smoothly, standing and walking for 4 ~ 72 h. After 4 dogs were transplanted into the pulmonary artery, one dog was anesthetized and awakened, and then acute pulmonary edema and systemic circulation Failure and death. Early lung ventilation after canine lung transplantation function well. CONCLUSION: Ischemia-reperfusion injury of lung transplantation is the main reason of lung function damage and acute pulmonary edema in the early stage. After body fluid treatment, the improvement of colloid osmotic pressure, respiratory tract management and the application of vasoactive drugs can reduce or delay the damage of lung function and acute Occurrence of pulmonary edema, to ensure ventilation for the lung function.