摘要
目的通过与传统静脉麻醉诱导比较,观察全凭七氟烷吸入麻醉诱导对行心脏手术患儿的影响。方法选择择期行心内畸形纠治术的非发绀型先天性心脏病患儿60例,随机分为全凭七氟烷吸入麻醉诱导组（S组,30例）和静脉麻醉诱导组（V组,30例）。两组患儿入手术室后均常规监测心电图（ECG）、脉搏血氧饱和度（SpO2）、无创血压（NIBP）。S组即行七氟烷诱导,3 min后进行气管插管,完成气管插管后依次穿刺外周静脉、桡动脉、颈内静脉,并于桡动脉穿刺成功后即采集动脉血进行血气分析。V组外周静脉置管成功后以咪达唑仑0.1~0.2 mg/kg、维库溴铵0.15 mg/kg、芬太尼5μg/kg行麻醉诱导,2 min后进行气管插管,完成气管插管后依次穿刺桡动脉、颈内静脉,并于桡动脉穿刺成功后即采集动脉血进行血气分析。记录两种麻醉方法的诱导情况、诱导期血流动力学的变化、不良反应、完成动脉穿刺后血气分析情况及手术结果。所有患者的麻醉均由高年资主治医师以上职称者完成。结果两组患儿经口插管均一次成功,S组在喉镜窥喉时有3例患儿出现轻微肢体运动,经口气管插管后有8例发生轻微呛咳,但均不影响气管插管。V组在喉镜窥喉时无体动,气管插管后有1例患儿发生轻微呛咳（P〈0.05）。S组入手术室至完成颈内静脉穿刺的时间为（32±6）min,显著短于V组的（37±7）min（P〈0.05）。两种麻醉诱导方法对患儿血压的影响相近,V组在气管插管前的心率显著低于S组（P〈0.05）。两组pH值、动脉血氧分压、动脉血二氧化碳分压的差异均无统计学意义（P值均〉0.05）,S组的碱剩余（BE）值显著低于V组（P〈0.05）。两组均无手术死亡患儿。结论全凭七氟烷吸入麻醉诱导方便、快捷,可应用于行心脏手术患儿的麻醉诱导,但可能会引起患儿的BE值降低。
Objective To observe the influence of sevoflurane inhalation induction for children with congenital heart disease by comparing with the conventional vein injection induction.Methods Sixty children with acyanotic congenital heart diseases,who were to receive elective heart surgery,were assigned randomly to two groups,S group with sevoflurane inhalation induction（n=30） and V group with conventional vein injection induction（n=30）.Both groups were connected to routine monitors electrocardiogram（ECG）,saturation pulse oxygen（SpO2）,noninvasive blood pressure（NIBP） right after arriving in the operating room.Patients in S group were given totally sevoflurane induction as soon as the monitors were connected.After 3 min mask ventilation with 8% sevoflurane and 8 L/min fresh gas flow of pure oxygen,patients in S group were intubated and maintained with 2% sevoflurane.Then the patients received peripheral vein,radial artery and central vein catheterization in order.Arterial blood gas samplings were performed right after artery catheterization.Patients in group V received peripheral vein catheterization（ketamine 6 mg/kg and atropine 0.01 mg/kg intramuscular injection to facilitate vein catheterization when necessary） right after connection of the routine monitors.Then patients were induced with midazolam 0.1-0.2 mg/kg,vecuronium 0.15 mg/kg,and fentanyl 5 μg/kg,and intubated 2 min thereafter,and also maintained with 2% sevoflurane.Then radial artery and central vein catheterization were performed in order.Arterial blood gas samplings were performed right after artery catheterization.Induction situation,hemodynamics,side effects,arterial blood gas results and surgical results were recorded in both groups.All procedures were performed by senior attending anesthetists.Results All patients in both groups were successfully intubated at the first try.Three patients in group S had slight extremity movement during laryngoscopy,and 8 patients had slight bucking after intubation,which did not influence intubation.No extremity movement was noticed in group V during laryngoscopy,and only 1 patient had slight bucking after intubation（P〈0.05）.The time from entering the operating room to finish of central vein catheterization was（32±6） min in group S,which was significantly lower than that in group V（ min,P〈0.05）.The blood pressures were similar in the two groups,and group V had a lower heart rate than group S before intubation（P〈0.05）.There were no significant differences in pH,pressure of arterial oxygen,and pressure of arterial carbon dioxide between the two groups,and the base excess（BE） in group S was significantly lower than that in group V（P〈0.05）.There was operation death in the two groups.Conclusion Sevoflurane inhalation induction is convenient and fast for cardiac anesthesia in preschool patients,but it may cause decrease of BE.（Shanghai Med J,2010,33： 521-524）
出处
《上海医学》
CAS
CSCD
北大核心
2010年第6期521-524,共4页
Shanghai Medical Journal
基金
上海市级医院适宜技术联合开发推广应用项目资助(SHDC12010222)
关键词
七氟烷
麻醉诱导
先天性心脏病
Sevoflurane
Anesthesia induction
Congenital heart disease
