小儿体外循环心脏手术麻醉管理方法在幼猪中的应用评价  

Evaluation of Anesthesia Management of Pediatric Cardiac Surgery with Cardiopulmonary Bypass on Piglets

作　　者：王晓凑[1] 薛庆华[1] 晏馥霞[1] 李立环[1] 李守军[2] 胡盛寿[2] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院麻醉科,北京100037 [2]中国医学科学院北京协和医学院阜外心血管病医院心脏外科,北京100037

出　　处：《实用儿科临床杂志》2012年第1期50-52,共3页Journal of Applied Clinical Pediatrics

基　　金：国家重点基础研究发展计划(973计划)资助项目(2010CB-529507)

摘　　要：目的评价小儿心脏手术的麻醉管理技术应用于幼猪低温低流量体外循环(CPB)心脏手术的全麻效果及其安全性。方法普通幼猪42只,基础麻醉采用氯胺酮加硫酸阿托品肌肉注射,麻醉诱导和维持采用芬太尼、哌库溴铵和咪达唑仑静脉注射,并辅助吸入七氟烷;CPB全流量后停止机械通气,给予可调压力限制阀0.49 kPa压力静态膨肺,主动脉开放后吸痰,手控通气膨肺,恢复机械通气;根据动脉血气结果纠正内环境紊乱,复温期间泵入多巴胺、多巴酚丁胺维持循环稳定,心律失常根据其类型给予相应的处理;监测并记录血流动力学指标、动脉血气分析指标、呼吸参数、麻醉总时间、主动脉阻断时间、CPB转机时间。结果 1只死于CPB后心脏骤停,余41只完成至实验终点,主动脉阻断时间为(125±8)min,CPB转机时间为(184±10)min,麻醉总时间为(335±17)min。结论小儿心脏手术麻醉管理方法应用于幼猪低温低流量CPB心脏手术全麻效果满意,且安全性高。Objective To evaluate the effectiveness and safety of anesthesia management of pediatric cardiac on piglets with low temperature and low flow cardiopulmonary bypass （CPB）. Methods Forty - two general - type piglets were utilized,with ketamine and atropine intramuscular injection as basal anaesthesia, fentanyl, pipecuronium bromide, midazolam were intravenously injected and sevoflurane was inhaled for anesthesia induction and maintenance. Mechanical ventilation was discontinued after full flow CPB ,0.49 kPa pressure of adjustable pressure limiting valve was used to keep lungs slightly inflated. Airway secretions were suctioned regularly and manual ventilation was given to ex- pand lungs once the circulation restarted, and then full mechanical ventilation was reinstated. Internal environment disorder was rectified according to the result of arterial blood gases analysis, and dopamine and dobutamine were intravenously injected by pump in order to maintain circulation steadiness,while arrhythmias was corrected according to their types. Haemodynamics, arterial blood gas analysis, breath parameters, duration of anesthesia, CPB and aorta arrest were monitored and recorded. Results One piglet died of heart arrest after CPB, while other 41 cases went through and completed the experiments. Durations of aortic cross clamp, CPB, and anesthesia maintain were （125 ± 8 ） min, （ 184 ± 10） min, （ 335 ± 17 ） min, separately. Conclusion Anesthesia management of pediatric cardiac surgery with CPB on piglets has preferable anesthesia effectiveness and safety.

关 键 词：麻醉管理 体外循环 心脏手术 幼猪 

分 类 号：R726.1[医药卫生—儿科]