小儿先天性心脏病并肺动脉高压心内直视手术的麻醉  

Anesthetic management of pediatric patients with congenital heart disease and pulmonary hypertension during open heart surgery

作　　者：王文祥[1] 孟凌新[1] 张锦[1] 马世贤[1] 

机构地区：[1]中国医科大学第二临床医院,沈阳市110003

出　　处：《中华麻醉学杂志》1996年第1期27-29,共3页Chinese Journal of Anesthesiology

摘　　要：小儿先天性心脏病并重症肺动脉高压心内直视手术64例的麻醉处理。麻醉方法以芬太尼、硫喷妥钠、泮库溴铵诱导,芬太尼、安氟醚或异氟醚、泮库溴铵维持。西门子900C麻醉呼吸机行机械通气。为防治转流后心功能不全,应加强停止转流前后的管理:(1) 心脏复跳后辅助循环时间要适当,采取慢过度小流量停止转流;(2) 心动过缓和房室传导阻滞时应使用起搏器;(3) 合理选用心血管活性药物;(4) 输血补充容量时注意不要超负荷;(5) 心脏明显增大病例不宜完全缝合心包。In this retrospective study. we evaluated the anesthetic management for open heart surgery in 64 patients. aged between 8 months and 14 years, suffering from congential heart disease, with pulmonary arterial pressure (PAP) 6.0 to 12.6 kPa. Scopolamine 0.007 mg/kg and either pethidine 1mg/kg or droperidol 0.1mg/kg were given intramuscularly as premedication. Anesthesia was induced with intravenous injections of thinpental, fentanyl (FT) and paneuronium (PAN). and was maintained with infusion of FT at large dose and intermittent bolus injections of droperidol and PAN. To reduce PAP. slight hyperventilation was conducted to keep PaCO_2 between 4.0 and 4.7 kPa, with airway pressure 1.47-1.96kPa. For the infant patient. the membrane oxygenator must be applied to attenuating the damage of blood cells during cardiopulmonary bypass (CPB). The following procedures were carried out to prevent low cardiac output syndrome immediately before and after the separation of CPB: 1. Following cardioversion. if the flow of CPB was descended to the rate at 30-40ml/kg/min. HR, MAP and CVP were kept at the levels of more than 100 beats/min. more than 6.65 kPa and less than 1.4 kPa respectively, CPS might be stopped. 2. Pacemaker should be installed if bradycardia was not corrected by isoprenaline, or auriculoventricular block occured, after cessation of CPB. 3. When cardiac failure happened, dopamine or combined with sodium nitroprusside, was infused at 5-10μg/kg/min. and if no improvement appeared, infusion of adrenaline and epinephine at 0.2-0.4μg/kg/min was adopted instead. 4. During blood transfusion, the rate was not more than 1-2 ml/kg/min and MAP and CVD must be monitored carefully. 5. Tight pericardial closing should be avoided for the patients with cardiac hypertrophy.

关 键 词：先天性心脏病 肺动脉高压 儿童 心内直视术 

分 类 号：R725.411[医药卫生—儿科]