Anesthetic Management Of PTE In Perioperative Period And Analysis Of The Postoperative Complications

Objective : To investigate the perioperative anesthetic management of pulmonary thrombendarterectomy(PTE)in Fuwai Hospital between May 2014 and October 2016,analysis of risk factors for adverse event after PTE,which can be able to provide a reliable basis for delicacy management of CTEPH in perioperative anesthetic management.Methods:Fuwai anesthetic management about PTE were applied to a total of 53 patients with chronic thromboembolic pulmonary hypertension(CTEPH)who were performed PTE from May 2014 to October 2016.The management is completed by intravenous anesthesia with a large dose of sufentanil,all patients inserted Swan-Ganz catheter,according to the results of the Swan-Ganz catheter intravenously pumped lyophilized recombinant human brain natriuretic peptide,norepinephrine,dopamine and other vasoactive drugs before extracorporeal circulation.We analysis of the patient’s general condition,management of anesthesia,adverse event,to explore the optimization method of perioperative management,analyze the related risk factors with adverse event.Results:There were 53 patients treated with operation.Their mean pulmonary arterial pressure decreased from(37.69 ± 13.02)mm Hg to(25.97 ± 11.60)mm Hg(P<0.001)after surgical operation.There are 4(7.5%)patients appear reperfusion edema,4(7.5%)patients appear severe infection,3(5.6%)patients has a tracheostomy because they need to be assisted ventilation for a long time,2(3.8%)patients appear pulmonary hypertension crisis,1(1.9%)patients appear pulmonary hemorrhage,1(1.9%)patients appear hypoxic ischemic encephalopathy.Results no death events in perioperative.The operation was completed smoothly in all the 53 patients.All patients showed a stable vital signs during the operation and returned to recovering room safely.The incidence of postoperative complications was significant lower compared with published research.There are 15 patients appear severe adverse event,such as severe infection,hypoxic ischemic encephalopathy,reperfusion edema,pulmonary hemorrhage,reoperation(pericardial drainage,debridement,chest drainage),using extracorporeal membrane oxygenation auxiliary treatment,needing tracheostomy or intubation assisted ventilation treatment again.Multiple linear regression analysis shows course of disease,right ventricular internal dimension,preoperative N-terminal pro B-type natriuretic peptide(NT-pro BNP)values have correlation with severity of adverse event.There are 44 patients follow-up postoperative 6 months,echocardiographic results show LVEDD increase,RV、s PAP decrease compared with preoperation,11(25%)patients are residual pulmonary hypertension.Conclusions:The Fuwai perioperative anesthetic management for PTE were more safe and effective at present.Course of disease,right ventricular internal dimension,preoperative NT-pro BNP values have a value to predict and guide severe adverse event occurrence after postoperation.