摘要
目的探讨三种浓度七氟烷吸入对小儿先天性心脏病手术患儿的麻醉效果、血流动力学变化及心肌酶水平的影响,为临床麻醉管理提供理论依据。方法选取2022年1月至2024年1月在河南省儿童医院(郑州儿童医院)进行手术的90例先心病患儿,根据随机数表法将患儿分为A组(低浓度组)、B组(中浓度组)、C组(高浓度组),分别给予吸入浓度为2.0%、2.5%、3.0%的七氟烷吸入麻醉。比较三组患儿的手术过程中的手术及麻醉相关时间(体外循环时间、主动脉阻断时间、转机时间、机械通气时间)、手术前、麻醉后、切皮后、心包悬吊后、手术完成时的血流动力学指标[平均动脉压(MAP)、心率(HR)]以及手术前、手术后6 h、手术后24 h、手术后48 h、手术后72 h的心肌酶水平[心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)]。结果三组患儿的体外循环时间、主动脉阻断时间、转机时间、机械通气时间分别为(50.07±9.07)min、(26.07±8.08)min、(45.08±13.07)min、(18.07±2.08)min,(53.03±10.09)min、(27.06±8.82)min、(44.06±14.04)min、(17.56±2.55)min,(49.11±9.47)min、(25.08±7.98)min、(46.05±12.08)min、(17.07±2.27)min,差异均无统计学意义(P>0.05);三组患儿的MAP、HR水平均分别先由(68.78±8.91)mmHg、(69.32±8.27)mmHg、(68.68±8.61)mmHg和(131.55±16.94)次/min、(130.57±16.74)次/min、(121.07±16.92)次/min降低至(59.72±8.03)mmHg、(59.89±7.69)mmHg、(60.27±7.86)mmHg和(116.12±9.72)次/min、(110.83±13.91)次/min、(105.78±15.62)次/min后,再升高至(67.42±6.71)mmHg、(66.07±8.72)mmHg、(65.05±5.38)mmHg和(128.07±9.91)次/min、(132.81±15.37)次/min、(124.05±13.48)次/min,随时间变化呈先降低再升高趋势,MAP在不同时间点差异有统计学意义(P<0.05),但组间差异及时间与组别的交互作用均无统计学意义(P>0.05);三组患儿的cTnI、CK-MB水平均分别先由(0.03±0.02)μg/L、(0.03±0.02)μg/L、(0.03±0.02)μg/L和(2.57±0.51)U/L、(2.57±0.62)U/L、(2.86±0.41)U/L升高为(7.78±1.77)μg/L、(6.71±2.16)μg/L、(4.48±1.11)μg/L和(24.53±4.11)U/L、(22.85±3.49)U/L、(18.85±2.62)U/L,再降低至(0.97±0.22)μg/L、(0.92±0.26)μg/L、(0.58±0.12)μg/L和(2.56±0.48)U/L、(2.07±0.32)U/L、(2.30±0.46)U/L,随时间变化呈先升高再降低趋势,差异均有统计学意义(P<0.05)。结论七氟烷的不同浓度对小儿先天性心脏病手术患儿的麻醉效果和心肌损伤有一定影响,2.5%的七氟烷进行麻醉有助于改善术后恢复及减少心肌损伤。
Objective To investigate the effects of three concentrations of sevoflurane inhalation on anesthetic efficacy,hemodynamic changes,and myocardial enzyme levels in children undergoing congenital heart disease surgery,providing a theoretical basis for clinical anesthesia management.Methods Ninety children with congenital heart disease who underwent surgery at Henan Children's Hospital(Zhengzhou Children's Hospital)from January 2022 to January 2024 were selected.According to the random number table method,the children were divided into group A(low concentration),group B(medium concentration),and group C(high concentration),receiving sevoflurane inhalation anesthesia at volume fractions of 2.0%,2.5%,and 3.0%,respectively.The intraoperative and anesthesia-related time(cardiopulmonary bypass time,aortic cross-clamp time,bypass time,mechanical ventilation time),hemodynamic indicators(mean arterial pressure[MAP],heart rate[HR])at pre-surgery,post-anesthesia,post-skin incision,post-pericardial suspension,and at surgery completion,as well as myocardial enzyme levels(cardiac troponinⅠ[cTnⅠ],creatine kinase isoenzyme[CK-MB])at pre-surgery,6 h,24 h,48 h,and 72 h post-surgery were compared among the three groups.Results The cardiopulmonary bypass time,aortic cross-clamp time,bypass time,and mechanical ventilation time were(50.07±9.07)min,(26.07±8.08)min,(45.08±13.07)min,(18.07±2.08)min in group A;(53.03±10.09)min,(27.06±8.82)min,(44.06±14.04)min,(17.56±2.55)min in group B;and(49.11±9.47)min,(25.08±7.98)min,(46.05±12.08)min,(17.07±2.27)min in group C,respectively,with no statistically significant differences among the three groups(P>0.05).The MAP and HR levels in the three groups initially decreased from(68.78±8.91)mmHg,(69.32±8.27)mmHg,(68.68±8.61)mmHg and(131.55±16.94)beats/min,(130.57±16.74)beats/min,(121.07±16.92)beats/min to(59.72±8.03)mmHg,(59.89±7.69)mmHg,(60.27±7.86)mmHg and(116.12±9.72)beats/min,(110.83±13.91)beats/min,(105.78±15.62)beats/min,respectively,and then increased to(67.42±6.71)mmHg,(66.07±8.72)mmHg,(65.05±5.38)mmHg and(128.07±9.91)beats/min,(132.81±15.37)beats/min,(124.05±13.48)beats/min,showing a trend of first decreasing and then increasing over time.The differences in MAP at different time points were statistically significant(P<0.05),but there were no significant differences between groups or in the interaction between time and group(P>0.05).The cTnI and CK-MB levels in the three groups initially increased from(0.03±0.02)μg/L,(0.03±0.02)μg/L,(0.03±0.02)μg/L and(2.57±0.51)U/L,(2.57±0.62)U/L,(2.86±0.41)U/L to(7.78±1.77)μg/L,(6.71±2.16)μg/L,(4.48±1.11)μg/L and(24.53±4.11)U/L,(22.85±3.49)U/L,(18.85±2.62)U/L,respectively,and then decreased to(0.97±0.22)μg/L,(0.92±0.26)μg/L,(0.58±0.12)μg/L and(2.56±0.48)U/L,(2.07±0.32)U/L,(2.30±0.46)U/L,showing a trend of first increasing and then decreasing over time,with statistically significant differences(P<0.05).Conclusion Different concentrations of sevoflurane have certain effects on anesthetic efficacy and myocardial injury in children undergoing congenital heart disease surgery.Anesthesia with 2.5%sevoflurane helps improve postoperative recovery and reduce myocardial injury.
作者
宗小川
邱永升
王帅
王佳
ZONG Xiao-chuan;QIU Yong-sheng;WANG Shuai;WANG Jia(Department of Anesthesia and Perioperative Medicine,Henan Children's Hospital(Zhengzhou Children's Hospital),Zhengzhou 450018,Henan,CHINA)
出处
《海南医学》
2025年第20期2973-2978,共6页
Hainan Medical Journal
基金
河南省医学科技攻关计划联合共建项目和软科学项目(编号:LHGJ20210686)。
关键词
先天性心脏病
七氟烷
麻醉效果
血流动力学
心肌酶
Congenital heart disease
Sevoflurane
Anesthetic effect
Hemodynamics
Myocardial enzyme
