中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2013年
1期
55-57
,共3页
导管插入术%心房功能,左%心脏缺损,先天性%高血压,肺性
導管插入術%心房功能,左%心髒缺損,先天性%高血壓,肺性
도관삽입술%심방공능,좌%심장결손,선천성%고혈압,폐성
Catheterization%Heart atria function,left%Heart defects,congenital%Hypertension,pulmonary
目的 评价术中置入左心房导管用于合并中重度肺动脉高压患儿先天性心脏病修复术后管理的效果.方法 择期CPB下行心脏修复术的先天性心脏病合并中重度肺动脉高压患儿60例,性别不限,年龄9个月～14岁,ASA分级Ⅲ或Ⅳ级,采用随机数字表法,将其随机分为2组(n=30):中心静脉置管组(C组)和左心房置管组(L组).全麻诱导后2组置入三腔中心静脉导管.L组经右颈内静脉置入单腔中心静脉导管,术中由术者经房间隔或卵圆孔置入左心房用于术后左心房压力(LAP)监测及血管活性药给药,术后维持LAP 8～ 12 mm Hg.记录机械通气时间和ICU停留时间.记录术后48 h内多巴胺、多巴酚丁胺、硝普钠、米力农、前列地尔的用量.结果 与C组比较,L组术后多巴胺、多巴酚丁胺、米力农、硝普钠、前列地尔用量减少,机械通气时间和ICU停留时间缩短(P＜0.05).结论 左心房导管监测LAP不仅可指导合理用药,还可提高治疗效果,优化合并中重度肺动脉高压患儿先天性心脏病修复术后管理的效果.
目的 評價術中置入左心房導管用于閤併中重度肺動脈高壓患兒先天性心髒病脩複術後管理的效果.方法 擇期CPB下行心髒脩複術的先天性心髒病閤併中重度肺動脈高壓患兒60例,性彆不限,年齡9箇月～14歲,ASA分級Ⅲ或Ⅳ級,採用隨機數字錶法,將其隨機分為2組(n=30):中心靜脈置管組(C組)和左心房置管組(L組).全痳誘導後2組置入三腔中心靜脈導管.L組經右頸內靜脈置入單腔中心靜脈導管,術中由術者經房間隔或卵圓孔置入左心房用于術後左心房壓力(LAP)鑑測及血管活性藥給藥,術後維持LAP 8～ 12 mm Hg.記錄機械通氣時間和ICU停留時間.記錄術後48 h內多巴胺、多巴酚丁胺、硝普鈉、米力農、前列地爾的用量.結果 與C組比較,L組術後多巴胺、多巴酚丁胺、米力農、硝普鈉、前列地爾用量減少,機械通氣時間和ICU停留時間縮短(P＜0.05).結論 左心房導管鑑測LAP不僅可指導閤理用藥,還可提高治療效果,優化閤併中重度肺動脈高壓患兒先天性心髒病脩複術後管理的效果.
목적 평개술중치입좌심방도관용우합병중중도폐동맥고압환인선천성심장병수복술후관리적효과.방법 택기CPB하행심장수복술적선천성심장병합병중중도폐동맥고압환인60례,성별불한,년령9개월～14세,ASA분급Ⅲ혹Ⅳ급,채용수궤수자표법,장기수궤분위2조(n=30):중심정맥치관조(C조)화좌심방치관조(L조).전마유도후2조치입삼강중심정맥도관.L조경우경내정맥치입단강중심정맥도관,술중유술자경방간격혹란원공치입좌심방용우술후좌심방압력(LAP)감측급혈관활성약급약,술후유지LAP 8～ 12 mm Hg.기록궤계통기시간화ICU정류시간.기록술후48 h내다파알、다파분정알、초보납、미력농、전렬지이적용량.결과 여C조비교,L조술후다파알、다파분정알、미력농、초보납、전렬지이용량감소,궤계통기시간화ICU정류시간축단(P＜0.05).결론 좌심방도관감측LAP불부가지도합리용약,환가제고치료효과,우화합병중중도폐동맥고압환인선천성심장병수복술후관리적효과.
Objective To evaluate the efficacy of catheterization of left atrium for postoperative management in pediatric patients undergoing congenital heart disease complicated with moderate to severe pulmonary hypertension.Methods Sixty ASA Ⅲ or Ⅳ pediatric patients of both sexes,aged 9 months-14 yr,scheduled for elective congenital heart disease complicated with moderate-to-severe pulmonary hypertension under cardiopulmonary bypass,were randomly divided into 2 groups (n =30 each):central venous catheterzation group (C group)and catheterization of left atrium group (L group).After induction of anesthesia,triple-lumen central venous catheters were inserted in both groups.In group L,the right internal jugular vein was cannulated with a single lumen venous catheter passed through the left atrium for monitoring postoperative left atrial pressure (LAP) and administration of vasoactive drug and LAP was maintained at 8-12 mm Hg after operation.Duration of mechanical ventilation and duration of stay in intensive care unit were recorded.The amount of dopamine,dobutamine,nitroprusside,milrinone,and alprostadil consumed within 48 h after operation was also recorded.Results Compared with C group,the amount of dopamine,dobutamine,nitroprusside,milrinone,and alprostadil consumed was significantly reduced and duration of mechanical ventilation and duration of stay in intensive care unit were significantly shortened in group L.Conclusion Catheterization of left atrium is used for monitoring postoperative LAP,which can provide a basis for reasonable clinical prescription and optimize the efficacy of postoperative management in pediatric patients undergoing congenital heart disease complicated with moderate to severe pulmonary hypertension.
