中国医药
中國醫藥
중국의약
CHINA MEDICINE
2013年
9期
1226-1228
,共3页
尹雁%张瑞冬%李书闻%欧阳川%卢家凯%程卫平
尹雁%張瑞鼕%李書聞%歐暘川%盧傢凱%程衛平
윤안%장서동%리서문%구양천%로가개%정위평
法洛四联症%心脏%麻醉
法洛四聯癥%心髒%痳醉
법락사련증%심장%마취
Tetralogy of fallot%Cardiac%Anesthesia
目的 比较法洛四联症(TOF)小儿心脏手术时采用不同麻醉诱导方案的效果和安全性.方法 将92例TOF患儿完全随机分成A、B、C组.A组患儿(31例)肌内注射氯胺酮5 mg/kg,B组患儿(31例)吸入8％七氟烷,待患儿入睡后分别静脉注射舒芬太尼1 μg/kg、顺式阿曲库铵0.15 mg/kg.C组患儿(30例)静脉注射咪达唑仑0.1 mg/kg、舒芬太尼2μg/kg、顺式阿曲库铵0.15 mg/kg.行动脉穿刺置管和气管插管,术中麻醉维持采用吸人七氟烷-空氧混合(1∶1)气体复合舒芬太尼2.5 μg/(kg·h)、顺式阿曲库铵100 μg/(kg·h)、丙泊酚4 mg/(kg,h)连续输注.记录患儿麻醉前(T1)、静脉给药后(T2)和气管插管后(T3)3个时间点的生命体征.在动脉穿刺后即刻(T4)和机械通气30 min后(T5)各进行1次动脉血气分析.结果 A、B、C组患儿T2、T3时点HR、SBP和DBP均明显低于T1时点(P＜0.05),而脉搏血氧饱和度均明显高于T1时点(P＜0.05).C组患儿T2、T3时点HR、SBP和DBP明显低于A、B组[T2:(128±18)次/min比(143±17)、(142±21)次/min,(90±19)mm Hg(1 mm Hg=0.133 kPa)比(95±18)、(97±14)mm Hg,(52±14) mm Hg比(55±22)、(54±18)mm Hg；T3:(118±23)次/min比(137±20)、(133±24)次/min,(85±17)mm Hg比(94±17)、(94±19)mm Hg,(47±15)mm Hg比(53±18)、(51±16)mm Hg；均P＜0.05].3组患儿T5时点动脉血氧饱和度明显高于T4时点[A组:(94±15)％比(88±14)％；B组:(92±12)％比(88±16)％；C组(91±15)％比(86±14)％；P＜0.05].结论 TOF患儿采用氯胺酮肌内注射、七氟烷吸入或大剂量舒芬太尼麻醉不会对血流动力学和血氧饱和度造成不良影响,因此均适用于心脏手术时的麻醉诱导.
目的 比較法洛四聯癥(TOF)小兒心髒手術時採用不同痳醉誘導方案的效果和安全性.方法 將92例TOF患兒完全隨機分成A、B、C組.A組患兒(31例)肌內註射氯胺酮5 mg/kg,B組患兒(31例)吸入8％七氟烷,待患兒入睡後分彆靜脈註射舒芬太尼1 μg/kg、順式阿麯庫銨0.15 mg/kg.C組患兒(30例)靜脈註射咪達唑崙0.1 mg/kg、舒芬太尼2μg/kg、順式阿麯庫銨0.15 mg/kg.行動脈穿刺置管和氣管插管,術中痳醉維持採用吸人七氟烷-空氧混閤(1∶1)氣體複閤舒芬太尼2.5 μg/(kg·h)、順式阿麯庫銨100 μg/(kg·h)、丙泊酚4 mg/(kg,h)連續輸註.記錄患兒痳醉前(T1)、靜脈給藥後(T2)和氣管插管後(T3)3箇時間點的生命體徵.在動脈穿刺後即刻(T4)和機械通氣30 min後(T5)各進行1次動脈血氣分析.結果 A、B、C組患兒T2、T3時點HR、SBP和DBP均明顯低于T1時點(P＜0.05),而脈搏血氧飽和度均明顯高于T1時點(P＜0.05).C組患兒T2、T3時點HR、SBP和DBP明顯低于A、B組[T2:(128±18)次/min比(143±17)、(142±21)次/min,(90±19)mm Hg(1 mm Hg=0.133 kPa)比(95±18)、(97±14)mm Hg,(52±14) mm Hg比(55±22)、(54±18)mm Hg；T3:(118±23)次/min比(137±20)、(133±24)次/min,(85±17)mm Hg比(94±17)、(94±19)mm Hg,(47±15)mm Hg比(53±18)、(51±16)mm Hg；均P＜0.05].3組患兒T5時點動脈血氧飽和度明顯高于T4時點[A組:(94±15)％比(88±14)％；B組:(92±12)％比(88±16)％；C組(91±15)％比(86±14)％；P＜0.05].結論 TOF患兒採用氯胺酮肌內註射、七氟烷吸入或大劑量舒芬太尼痳醉不會對血流動力學和血氧飽和度造成不良影響,因此均適用于心髒手術時的痳醉誘導.
목적 비교법락사련증(TOF)소인심장수술시채용불동마취유도방안적효과화안전성.방법 장92례TOF환인완전수궤분성A、B、C조.A조환인(31례)기내주사록알동5 mg/kg,B조환인(31례)흡입8％칠불완,대환인입수후분별정맥주사서분태니1 μg/kg、순식아곡고안0.15 mg/kg.C조환인(30례)정맥주사미체서륜0.1 mg/kg、서분태니2μg/kg、순식아곡고안0.15 mg/kg.행동맥천자치관화기관삽관,술중마취유지채용흡인칠불완-공양혼합(1∶1)기체복합서분태니2.5 μg/(kg·h)、순식아곡고안100 μg/(kg·h)、병박분4 mg/(kg,h)련속수주.기록환인마취전(T1)、정맥급약후(T2)화기관삽관후(T3)3개시간점적생명체정.재동맥천자후즉각(T4)화궤계통기30 min후(T5)각진행1차동맥혈기분석.결과 A、B、C조환인T2、T3시점HR、SBP화DBP균명현저우T1시점(P＜0.05),이맥박혈양포화도균명현고우T1시점(P＜0.05).C조환인T2、T3시점HR、SBP화DBP명현저우A、B조[T2:(128±18)차/min비(143±17)、(142±21)차/min,(90±19)mm Hg(1 mm Hg=0.133 kPa)비(95±18)、(97±14)mm Hg,(52±14) mm Hg비(55±22)、(54±18)mm Hg；T3:(118±23)차/min비(137±20)、(133±24)차/min,(85±17)mm Hg비(94±17)、(94±19)mm Hg,(47±15)mm Hg비(53±18)、(51±16)mm Hg；균P＜0.05].3조환인T5시점동맥혈양포화도명현고우T4시점[A조:(94±15)％비(88±14)％；B조:(92±12)％비(88±16)％；C조(91±15)％비(86±14)％；P＜0.05].결론 TOF환인채용록알동기내주사、칠불완흡입혹대제량서분태니마취불회대혈류동역학화혈양포화도조성불량영향,인차균괄용우심장수술시적마취유도.
Objective To evaluate the effect and safety of different anesthetic induction regimens in children with tetralogy of fallot (TOF) during cardiac surgery.Methods Ninety-two TOF patients [American society of anesthesiologists(ASA) Ⅱ-Ⅲ,aged 6 months-3 old years,weighing 5.8-14 kg],were randomly assigned to three groups.Following patients received ketamine 5 mg/kg intramuscular injection in group A (n =31),patients inhaled 8％ sevoflurane in group B (n =31),both groups were given intravenously sufentanil 1 μg/kg and cis-atracurium 0.15 mg/kg when patients had fallen asleep.Individually,patients in group C (n =30) received midazolam 0.1 mg/kg,sufentanil 2 μg/kg and cis-atracurium 0.15 mg/kg intravenously.After arterial cannulation and intubation,sevoflurane-air-oxygen inhalation combinated with sufentanil 1 μg/(kg · h),cis-atracurium 100 μg/(kg · h),propofol 4 mg/kg continously intravenous injection were used to anesthetic maintenance.Vital signs of patients were recorded before anesthesia (T1),after intravenous administration (T2),after intubation (T3).Respectively,arterial blood gas was analyzed after arterial cannulation (T4),30 minutes after mechanical ventilation (T5).Results Heart rate,systolic pressure,dystolic pressure of all patients at T2 and T3 were significantly lower than those at T1 (P ＜ 0.05),pulse oxygen saturation (SpO2) incresed conversely (P ＜ 0.05).Heart,systolic blood pressure,diastolic blood pressure of patients in group C at T2,T3 were lower than those of patients in group A and group B [T2:(128 ± 18)times/min vs (143 ± 17),(142 ±21)times/min,(90 ± 19)mm Hg(1 mm Hg=0.133 kPa)vs (95 ± 18),(97 ± 14)mm Hg,(52 ± 14)mm Hg vs (55 ±22),(54 ± 18)mm Hg; T3:(118 ± 23) times/min vs (137 ± 20),(133 ± 24) times/min,(85 ± 17) mm Hg vs (94 ± 17),(94 ± 19) mm Hg,(47 ± 15) mm Hg vs (53 ± 18),(51 ± 16)mm Hg; all P ＜0.05],but there was no SpO2 difference among three groups(P ＞0.05).Arterial oxygen saturation at T5 got more significant improvement than at T4 in 3 groups [group A:(94 ± 15)％ vs(88 ±14)％; group B:(92 ±12)％ vs (88 ±16)％; group C(91 ±15)％ vs (86 ±14)％; P＜0.05].Conclusions It seems that induction with ketamine and sevoflurane and large dose of sufentanil have no significant adverse effects on hemodynamics and oxygen saturation in TOF patients.Therefore,these three programs are able to apply to anesthetic induction in TOF cardiac surgery.
