CAJ | 학술논문

目的探讨新生儿复杂先天性心脏病手术的麻醉管理。方法回顾性分析2008年9月至2012年10月诊断为复杂先心病的并在本院进行了手术治疗的72例新生儿。入院后积极完善术前检查，行超声心动图、CT检查明确诊断。术前在新生儿监护室强心利尿抗感染治疗，室隔完整的大血管错位/肺动脉闭锁患儿给予泵入凯时，保持动脉导管开放；术中所有患儿以PCV模式进行机械通气，采用静吸复合方法维持麻醉，停转流前联合应用多种血管活性药改善心功能。体外循环复温时期行平衡超滤，停转流后行改良超滤。结果 72例手术麻醉效果满意，术中没有出现由麻醉引起的血液动力学明显改变。结论成功的新生儿复杂先心手术麻醉，应从术前准备开始，尽可能纠正低氧、酸碱电解质紊乱，积极合理地应用血管活性药以及严格控制输液，维持合适的前负荷等，整个围术期的精细管理是保证手术后顺利恢复的必要条件。
목적탐토신생인복잡선천성심장병수술적마취관리。방법회고성분석2008년9월지2012년10월진단위복잡선심병적병재본원진행료수술치료적72례신생인。입원후적겁완선술전검사，행초성심동도、CT검사명학진단。술전재신생인감호실강심이뇨항감염치료，실격완정적대혈관착위/폐동맥폐쇄환인급여빙입개시，보지동맥도관개방；술중소유환인이PCV모식진행궤계통기，채용정흡복합방법유지마취，정전류전연합응용다충혈관활성약개선심공능。체외순배복온시기행평형초려，정전류후행개량초려。결과 72례수술마취효과만의，술중몰유출현유마취인기적혈액동역학명현개변。결론 성공적신생인복잡선심수술마취，응종술전준비개시，진가능규정저양、산감전해질문란，적겁합리지응용혈관활성약이급엄격공제수액，유지합괄적전부하등，정개위술기적정세관리시보증수술후순리회복적필요조건。
Objective To investigate specified anesthesia management for neonatal with complex congenital heart disease. Methods A retrospective analysis of 72 neonatal, with a diagnosis of complex congenital heart disease undertaking operation and treatment from 2008 September to 2012 October, Ultra-echocardiograph and CT examination perioperatively was taken to specify the diagnosis after admission. Neonatal suffering transposition of great vessels or pulmonary atresia were administrated with medication enhancing heart function and antiinfected therapy, at the same time, pumped PGE1 to keep the patent ductus arterious open preoperatively; during surgery all children, anesthetized with inhalation combined with intravenous kef, were applied with PCV mode of mechanical ventilation, administrated with effective vasoactive drugs to improve the output before weaning, taken balanced ultrafiltration therapy when re-warming, and given modified ultrafiltration after weaning.Results: 72cases, with satisfied anesthesia effect, succeeded with unobvious hemodynamics changes caused by anesthesia. Conclusion: successful anesthesia for neonatal suffering complex congenital heart disease, preoperatively prepared sufficiently from skin to skin as far as possible, such as the correction of hypoxia, the balancing of acid-base or electrolyte disorder, active and reasonable application of vasoactive drugs and strict control of infusion and proper preload, which is the key to the specified anesthesia management to ensure the operation going to the successful recovery