小儿胸腔镜下心脏手术的麻醉管理  

Anesthetic management for totally thoracoscopic surgery in pediatric congenital heart diseases treatment

作　　者：王显悦[1] 俞世强[1] 徐学增[1] 杨剑[1] 魏旭峰[1] 李杨[1] 陈涛[1] 易定华[1] 

机构地区：[1]第四军医大学西京医院心血管外科,陕西西安710032

出　　处：《中国内镜杂志》2007年第10期1043-1045,共3页China Journal of Endoscopy

基　　金：国家"十五"科技攻关项目(2004BA720A12)

摘　　要：目的探讨小儿胸腔镜下心脏手术的麻醉管理方法。方法选取同期147例行胸腔镜手术(TTS)和常规正中开胸心脏手术(MS)的小儿,分为TTS组和MS组。其中TTS组81例先天性心脏病患儿,年龄(8±3)岁,MS组66例先天性心脏病患儿,年龄(7±4)岁,均采用全身麻醉单腔气管插管中低温体外循环下手术。记录两组手术相关时间及TTS组在不同潮气量时氧分压和二氧化碳分压的改变。结果两组患儿手术顺利,无重要并发症。TTS组麻醉过程中潮气量设定在4～10mL/kg区间变化时二氧化碳分压呈直线性改变,而氧分压改变不明显。TTS组与MS组相比手术时间较长(P<0.01),而术后ICU时间明显缩短(P<0.01),住院时间、主动脉阻闭时间、呼吸机辅助呼吸时间差异无显著性(P>0.05)。结论术前充分准备和术中全面监测,尤其是术中改良单腔管双肺肺通气以及加强呼吸管理是麻醉管理的关键。[Objective ] To investigate anesthetic management in totally thoracoscopic surgery for pediatric cardiac septal defect. [Methods] 147 patients with congenital heart diseases were incorporated in this study. 81 patients （TTS group） aged （8＋3） years were randomly sampled from TTS cases, while 66 （MS group） from MS aged （7± 4） years for pediatric cardiac septal defect. The patients were intubated with single-lumen endobroncheal tube under general anesthesia with moderate hypothermia CPB. The changes in O2 and CO2 pressure under different tidal volume and operation related time were investigated. [Results] All operations were successful without critical complication. During anesthesia C02 pressure increased linearly and O2 pressure changed unclearly with reduction of tidal volume. Operating times were longer in the TTS group than in the MS group （P 〈0.01）, while TTS patients had shorter stays in the intensive care unit than MS patients did （P 〈0.01）. The aortic clamp time, length of stay and ventilation time in TIS group had no significant difference to those in MS group （P 〉0.05）. [Conclusion] It is critical during anesthesia management to make sufficient preparation before operation and intensive care during operation, especially changing ventilate methods to expose operation area and strengthening the breathing management.

关 键 词：麻醉 电视胸腔镜手术 小儿 室间隔缺损 房间隔缺损 

分 类 号：R725.4[医药卫生—儿科]