摘要
目的：比较舒芬太尼复合咪达唑仑与七氟烷麻醉诱导,对室间隔缺损修补术患儿血流动力学的影响。方法：择期行室间隔缺损矫治术的1~5岁患儿32例,体质量（12.1±3.1）kg,随机分为静脉组（SM组）和吸入组（S组）。肌注氯胺酮待患儿入睡后,穿刺动脉置管,建立监测。SM组依次给予咪达唑仑-哌库溴铵-舒芬太尼,5分钟肌肉松弛后行气管插管。S组吸入七氟烷,并予哌库溴铵,维持吸入呼末浓度2.0 MAC,5分钟气管插管。使用Mostcare监测仪记录肌注氯胺酮后（T0）、麻醉诱导用药后1分钟（T1）、2分钟（T2）、5分钟（T3）、插管后1分钟（T4）、2分钟（T5）、5分钟（T6）和10分钟（T7）的HR、SBP、DBP、每搏输出量指数（SVI）、心排血量指数（CI）、体循环阻力指数（SVRI）、反映左心室收缩功能的压力升支最大速率（dp/dt）和心动周期效率（CCE）。结果：肌注氯胺酮到诱导后5分钟时间段（T0~T3）：静脉组HR明显下降（P〈0.01）,吸入组HR先下降后上升（P〈0.01）;两组SBP、DBP、CI、SVI、dp/dt及CCE均明显下降（P〈0.01）。CCE组别因素与时间因素存在交互作用（P〈0.05）。诱导后5分钟到插管后,10分钟时间段（T3~T7）：两组HR、SBP、DBP及dp/dt插管后先上升后下降（P〈0.01）,CI、SVI上升（P〈0.01）,SVRI下降（P〈0.01）。两组CCE比较,静脉组高于吸入组（P〈0.05）。结论：1咪达唑仑复合舒芬太尼静脉麻醉与吸入七氟烷的麻醉诱导方法,均能满足心室间隔缺损修补术患儿的麻醉诱导要求,均可维持dp/dt、CI于正常范围,是安全可靠的诱导用药。2舒芬太尼复合咪达唑仑对循环功能影响更轻,可能更适合循环功能低下的患儿。
Objective： To compare sufentanil-midazolam with sevoflurane on hemodynamic effects for anesthetic induction in children with ventricular septal defect undergoing cardiac surgery. Methods： 32 chil- dren[from 1 to 5 years old,weight（ 12. 1 ± 3. 1 ）kg] with ventricular septal defect undergoing complete repair surgery were randomly divided into intravenous group （Group SM） and inhalation group （Group S）. After intra- muscular injection of ketamine, puncture radial artery or femoral artery on patients. Midazolam-pipecuronium- sufentanil were given in turn to complete induction of anesthesia in Group SM, while sevoflurane was adjusted to 2.0 MAC and intravenous pipecurouium in Group S. Then intubation 5 rains later. Hemodynamic data recorded by Mostcare included HR, SBP, DBP, SVI, CI, SVRI, the maximal slope of systolic upstroke （dp/dt） and CCE （cardiac cycle efficiency） after injection of ketamine （T0）, 1, 2, 5-min after induction completed （T1, T2, T3, respectively）, and 1, 2, 5 and 10-min after intubation （T4, TS, T6, T7, respectively）. Results： From TO to T3： In Group SM, HR decreased significantly （P 〈 0. 01 ）, in Group S, HR showed a decrease,followed by an increase （P 〈 0. 01 ） ; SBP, DBP, CI, SVI, dp/dt, CCE showed significant decrease （P 〈 0.01 ） in both groups. There existed an interaction effect in CCE between group factor and time factor （P 〈 0.05）. From 33 to T7 ： In both groups, HR, SBP, DBP, dp/dt showed an increase post-intubation, followed by a decrease （P 〈 0. 01 ）, CI and SVI showed increase （ P 〈 0. 01 ）, SVRI showed decrease （ P 〈 0. 01 ） ; CCE were higher in Group SM than that in Group S （ P 〈 0. 05 ）. Conclusion： Intravenous sufentanil-midazo- lam and inhalation of sevoflurane were applicable to anesthetic induction for children with left-to-right shunts undergoing surgery. Sufentanil-midazolam affected hemodynamics less and may be more suitable for children with circulation dysfunction and less tolerant of anesthetic induction.
出处
《心肺血管病杂志》
CAS
2015年第10期759-763,共5页
Journal of Cardiovascular and Pulmonary Diseases
关键词
麻醉诱导
舒芬太尼
咪达唑仑
七氟烷
血流动力学
室间隔缺损
Anesthetic induction
Sufentanil
Midazolam
Sevoflurane
Hemodynamics
Ventricular septal defect
