摘要
目的探讨小儿发绀型先天性心脏病改良Fontan手术的麻醉管理。方法142例发绀型先天性心脏病患儿，年龄3月～14岁，体质量3．5～34kg。所有病例均在静吸复合麻醉下完成手术。术前口服咪达唑仑糖浆，静注咪达唑仑、芬太尼和维库溴铵诱导后行气管内插管。通气模式采用压力控制通气（PCV），术中分次静注芬太尼和持续输注维库溴铵维持麻醉，并辅以02-ISO吸入。连续监测心电图（ECG）、动脉血压（ABP）、中心静脉压（CVP）、脉搏血氧饱和度（SpO2）和心率（HR）等，并定时进行血气分析。停转流后通过控制气道压力、输血补液及适量应用血管活性药物等综合处理，维持血流动力学稳定。结幂142例患儿中140例在体外循环下实施手术，体外循环时间（146．28±48．36）min，主动脉阻断时间（76．42±30．54）min；127例心脏自动复跳（89．44％），电击除颤复跳15例（10．56％）。术后早期死亡23例（16．2％），原因为多脏器功能衰竭、低心排综合征、心力衰竭及脑血管意外等。全组无因麻醉死亡病例。结论术中维持低状态肺血管阻力和较高水平的右房压，增加心肌收缩力，降低体循环阻力以维持心排量和循环功能，是小儿改良Fontan手术麻醉尤其是体外循环后麻醉管理的关键。
Objective To review the experiences of the anesthetic management of pediatric patients undergoing modified Fontan procedure for cyanotic congenital heart disease. Methods One hundred and forty-two pediatric patients （aged 3 months to 14 years, weighted 3.5 kg to 34 kg） received modified Fontan procedure. All cases accomplished surgery with general anesthesia, premedicated with syrup of midazolam p.o. After i.v. induction of anaesthesia with midazolam, fentanyl and vecuronium bromide, anesthesia was maintained with vecuronium bromide infusion and O2-ISO inhalation. After cardiopulmonary bypass（CPB） , haemodynamics stabilization was maintained by controlling airway pressure, blood transfusion and properly using vasoactive agents. During the whole operation time, electrocardiogram （ECG）, arterial blood pressure （ABP）, central venous pressure（CVP）, pulse oximetric saturation （SpO2） and heart rate （HR） were continuously monitored, and blood gas analysis was detected at intervals. Results One hundred and forty children underwent the operation on CPB, with duration of CPB of （ 146.28± 48.36） min and duration of aortic cross-clamp of （76.42±30.54） min. At the end of CPB, 127 （89.44%） children＇s hearts rebeat spontaneously and 15 （10.56%） needed electric defibrillation. Twentythree children （16.2%） died from multiple organ system failure, low cardiac output syndrome, cardiac failure and cerebrovascualr accident earlier postoperation. None died from anesthesia. Conclusion Maintaining lower pulmonary vascular resistance as well as higher right atrial pressure, strengthening myocardial contraction and decreasing systemic vascular resistance to maintain cardiac output and circulative function may be the key to the anesthetic management of Fontan procedure.
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2007年第10期1244-1247,共4页
Journal of Shanghai Jiao tong University:Medical Science
关键词
FONTAN手术
先天性心脏病
麻醉管理
儿童
Fontan procedure
congenital heart disease
anesthetic management,pediatrics
