先心病病人非心外手术的麻醉

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1、AnesthesiaforthePatientWithCongentialHeartDiseaseForNonCardiacSurgeryRi許逵翔/蔡易臻/羅偉成/CR章宏吉/V.S.黃啟祥BackgroundContinuousimprovementinmedicalcareandsurgicaltreatmentlongerthelifespanofcongentialHeartDisease(CHD)patient1.2millionadults(>16years)livingwithvariou

2、sformsofCHDintheU.S.Therecommendations-HowtocareCHDpatient?-Centersthathavemulti-disciplinaryCHDprogramsandstaffEverypediatriccardiologyprograminthecentershouldidentifyaspecialized,dedicatedCHDprogramforthetransitionoftheirpatients.這是過渡期(兒童期)須有小兒心臟專家Patie

3、ntswithmoderateorsevereACHDshouldbetransferredtoadedicatedACHDprogramforurgentoracutecareForAnesthesia-HowtocareaboutCHDpatient?-DedicatedcardiacanesthesiateamwithexpertiseinthemanagementofCHDWellconsultativeservicesandinteractsatalllevelsWhoisactuallyrep

4、aired?VeryfewtypesofcongenitalheartdiseasearetrulyfixedwithnoresidualproblemsExcept:PDAligationUncomplicatedsecundumASDUncomplicatedVSDPathophysiologyofchronicCHDventricularoverloadrepeatedmyocardialischemiaalteredcoronaryarterysupplychronichypoxemiainadeq

5、uatemyocardialprotectionAlternormaldevelopmentofcardiovascularsystemConsequencesofCongenitalHeartDiseaseConsequencesofCongenitalHeartDiseaseCHFHypoxemia,cyanosisPolycythemiaPulmonaryvasculardiseasePrevioussurgicalsequenceAlternormalgrowthandcardiovascular

6、developmentKeyinapproachingtheCHDpatientMostimportantconsiderationinapproachingthepatient:potentialtodeveloporexacerbatelowsystemiccardiacoutputTheotherpossibleriskfactors:contractiledysfunctionthepressure-orvolume-loadedventriclepulmonaryhypertensionend-o

7、rgandysfunctionAtrialseptaldefectmostsuccessfulASDrepairscarrylittleriskoflatecomplicationsHowever,ifthedefectclosedlatepulmonaryhypertensionmaydevelopin20~30yearsPersistentatrialarrhythmiasVentricularSeptalDefectIftheVSDisnon-complicatedthedefectisclosede

8、arlynoresidualVSDofsignificancenoassociatedlesionsex.outflowobstruction,subaorticmembrane,heartblockFunctionarelikelytobenormalHowever,incomplicatedpatientLVdysfunction,pulmonaryhypertensionmaydevelopedAorti