法洛四联症39例手术的麻醉管理  

Anesthetic management of 39 cases with tetralogy of Fallot

作　　者：史素丽[1] 张鸿毅[2] 张改焕[2] 王泽霞[2] 

机构地区：[1]山西省儿童医院麻醉科,030013 [2]山西省儿童医院心外科,030013

出　　处：《中国药物与临床》2005年第12期897-898,共2页Chinese Remedies & Clinics

基　　金：国家"十五"攻关课题基金资助项目(2002BA709B09)

摘　　要：目的根据法洛四联症(TOF)的病理特征及其导致的血流动力学变化,探讨TOF根治术的麻醉管理方法。方法分析39例法洛四联症患儿术前准备,麻醉诱导、维持用药,术中监测,并发症及病死率。结果患儿发绀消失,血氧饱和度达98%￣100%。动脉氧分压皆在100mmHg以上。本组术后因脑血管先天畸形,术后出血死亡2例,系统性毛细管渗漏综合征死亡1例。血流动力学及血气分析结果均较稳定。结论防止右向左分流增加而导致的严重动脉血氧饱和度下降和低血压是麻醉管理的重点。心肺分流术(CPB)前应尽量维护血流动力学的平稳,术中缩短体外循环的时间,做好心肌保护;体外循环后恰当应用正性肌力药和血管扩张药。Objective To delve into the methods of anesthetic management for children with tetralogy of Fallot （TOF） on operation according to their pathologico-anatomic characters and corresponding hemodynamic changes.Methods Analyzing data of 39 cases with TOF about their preoperative preparation,anesthetic induction,maintenance dosing, perioperative monitoring,complication and mortality, Results Hemodvnamic and blood gas analysis showed stable data on operation,Patients became pink postoperatively with SaO2 98%～100% and PaO2 〉 100%;3 patients were dead： 2 for cerebrovascular malformation leading to encepbalorrhagia,1 for systemic capillary leak syndrome （SCLS）. Conclusion Before patient＇s cardiopulmonary bypass （CPB）,trying to make hemodynamic index stable is very important,which could prevent the increase of right to left shunt that may lead to severe decrease of SaO2 and arterial blood pressure. Moreover,shortening the CPB time,doing well the myocardium protection,and appropriately using of inotropic agents and vasodilators after CPB are also significant.

关 键 词：法乐四联症 麻醉管理 

分 类 号：R726.1[医药卫生—儿科]