胎羊体外循环中的麻醉管理  

Anesthetic management during cardiac bypass in fetal lambs

作　　者：周成斌[1] 庄建[1] 温树生[1] 祁周措[2,3] 姚丽明[2,3] 

机构地区：[1]广东省人民医院,广东省心血管病研究所,广东省医学科学院心血管外科,广东广州510080 [2]广东省人民医院,广东省心血管病研究所 [3]广东省医学科学院中心实验室,广东广州510080

出　　处：《南方医科大学学报》2009年第12期2401-2403,共3页Journal of Southern Medical University

基　　金：国家自然科学基金项目(30300346);广东省自然科学基金项目(033187)

摘　　要：目的总结胎羊体外循环研究中的麻醉方法。方法5头孕羊(孕120～140d)氯胺酮基础麻醉,芬太尼和维库溴铵维持麻醉。气管插管,机械通气,补充容量和硫酸镁。维持孕羊平均动脉压(MAP)大于70mmHg。经子宫壁肌肉注射胎羊麻醉药物(芬太尼25～50μg/kg,维库溴铵0.1～0.2mg/kg),建立胎羊腋动脉通路。胎羊肺动脉、右房分别插管,建立体外循环,转流30min,停机后观察2h。监测孕羊、胎羊MAP、心率(HR)和动脉血气。B超机监测胎羊脐动脉和孕羊子宫动脉的搏动指数(PI)。结果实验过程中胎羊MAP和HR没有显著变化。转流结束后胎羊脐动脉PI值明显增高,出现高碳酸血症和酸中毒(P<0.05)。孕羊MAP和HR没有明显变化,血液氧合充分。子宫动脉PI值在转流期间低于转流前(P<0.05),转流结束后PI值与转流前没有显著差异。结论维持母体高循环动力状态,使用抑制宫缩药物,加强胎羊麻醉期间的监护,有利于胎羊体外循环的研究。Objective To summarize the anesthetic management in fetal lamb cardiac bypass. Methods Five ewes at 120-140 days of gestation were anesthetized intramuscularly with katamine hydrochloride, intubated and ventilated with a respirator. Anesthesia was maintained with fentanyl and vecuronium. Lactated Ringer＇s solution and magnesium sulfate were infused to maintain the mean blood pressure （MAP） over 70 mmHg and uterine relaxation. The fetal lambs received anesthesia with fentanyl and vecuronium intramuscularly via the uterine wall. Fetal cardiac bypass was established with pulmonary artery and right atrium cannulation, lasting for 30 min. The hemodynamic and blood gas data of the ewes and fetal lambs were recorded before bypass, at 30 min during bypass, and at 1 and 2 h after cessation of bypass. The pulse index of the umbilical artery （PIua） and the ewe＇s uterine artery （PIeu） were monitored simultaneously. Results The MAP and heart rate （HR） of the fetus remained normal during the anesthesia. PIua increased significantly after cessation of bypass （P0.05）. Although the fetal oxygen tension in the axillary artery remained normal, the fetal lambs showed hypercarbia and acidosis after cessation of bypass （P0.05）. The maternal MAP and HR remained normal. The PIeu decreased significantly during bypass （P0.05） and recovered the normal level after cessation of bypass. The arterial blood gas of the ewes was normal during the experiment. Conclusion Maintaining high hemodynamics in the ewes, application of uterine relaxation and intensive care during anesthesia are crucial in anesthetic management of cardiac bypass in fetal lambs.

关 键 词：胎儿 体外循环 心血管麻醉 

分 类 号：R714.5[医药卫生—妇产科学] R614[医药卫生—临床医学]