阿曲库铵全麻联合呼吸机控制通气在小儿先心病介入治疗中的应用  

Application of total anesthesia using atracurium combined with controlled ventilation breathing machine in transcatheter closure of congenital heart diseases of children

作　　者：宋铁鹰[1] 王文立[2] 王虹[3] 沈书斌[1] 王军[4] 高秀江[4] 

机构地区：[1]石家庄市第一医院,河北石家庄050011 [2]石家庄市第六医院 [3]石家庄市第九医院 [4]河北医科大学第一医院

出　　处：《山东医药》2007年第36期12-13,共2页Shandong Medical Journal

基　　金：河北省科学技术研究与发展计划项目(06276163)

摘　　要：目的探讨阿曲库铵全麻联合呼吸机控制通气用于小儿先天性心脏病（先心病）介入治疗的可行性与安全性。方法200例ASA分级Ⅰ～Ⅱ级先天性心脏病患儿介入治疗。随机分为两组，各100例。观察组静注芬太尼3μg／kg、丙泊酚2mg/kg、阿曲库铵0．3mg／kg麻醉，气管插管呼吸机辅助通气；对照组氯胺酮50μg（kg·min）、丙泊酚50μg/（kg·min）持续微量静脉泵注人，保留自主呼吸。比较两组患儿术中屏气呛咳例数、血氧饱和度（SpO2）〈90％例数、苏醒时间、最低SpO2。结果观察组术中无屏气呛咳和SpO2〈90％者，苏醒时间（16．8±4．5）min，最低SpO2（95．8±3．4）％；对照组屏气呛咳20例，SpO2〈90％者，8例，苏醒时间（62．0±22．1）min，最低SpO2（86．8±8．2）。观察组均优于对照组（P均〈0．05）。结论阿曲库铵复合全麻配合呼吸机控制通气用于小儿先天性心脏病介入治疗，可基本消除术中呛咳屏气，避免缺氧，患儿术中安静，术后苏醒迅速，安全可行。[ Objective] To investigate the feasibility and security about the technology of total anesthesia using atracurium combined with controlled ventilation breathing machine in transcatheter closure of congenital heart diseases of children. [ Methods ] 200 children of ASA Ⅰ or Ⅱ in transcatheter closure of congenital heart aged were randomly divided into 2 groups（ n = 100 each）. Fer atracurium group, was induced with fentanyl 3 μg/kg, propofol 2 mg/kg and atracurium 0.3 mg/kg ,then tracheal intubation was performed and mechanical ventilation was started; for control group,anesthesia was maintained with ketamine 50 μg/（ kg · min） and propofol 50 μg/（ kg · min） , spontaneously breathing was reserved. The cases of breathholding, bucking and SpO2 lower than 0.90, the conscious time and the lowest SpO2 were compared between two groups. [ Results] The cases of breathholding, bucking and SpO2 lower than 0.90, the conscious time and the lowest SpO2 of atracurium group were superior to control group, but there were no differences in age, weight, sex and the operation time. [ Conclusion ] Fentanyl, propofol and atracurium general anesthesia combined with controlled ventilation using breathing machine in transcatheter closure of congenital heart diseases of children is safe and effective, with breathholding, bucking and hypoxia avoided, the children are quiet in operation and conscious quickly.

关 键 词：先天性心脏病 麻醉 呼吸机 介入疗法 

分 类 号：R725.4[医药卫生—儿科]