双向Glenn分流术治疗儿童复杂紫绀型先天性心脏病的麻醉处理  

Anesthesia management of bidirectional Glenn shunt in children with complex cyanotic congenital heart disease

作　　者：谭杰[1,2] 于湘友[1] 张为民[3] 潘鹏飞[4] 

机构地区：[1]新疆医科大学第一附属医院重症医学科,乌鲁木齐830054 [2]新疆维吾尔自治区人民医院北院 [3]新疆维吾尔自治区人民医院北院心脏中心 [4]重庆三峡中心医院重症监护科

出　　处：《上海医学》2012年第2期105-107,共3页Shanghai Medical Journal

基　　金：新疆维吾尔自治区自然科学基金(2011211A065);新疆维吾尔重点学科(麻醉学)建设经费(自治区级重点学科建设经费)资助

摘　　要：目的回顾总结双向Glenn分流术治疗儿童复杂紫绀型先天性心脏病的麻醉处理经验。方法 2007年1月-2009年12月,新疆医科大学第一附属医院对24例复杂紫绀型先天性心脏病患儿行双向Glenn分流术,年龄4个月～14岁,体重6～30kg。以芬太尼5～10μg/kg、维库溴铵0.1～0.15mg/kg、氯胺酮1mg/kg静脉注射行麻醉诱导。分别于右侧颈内及右股静脉置入双腔静脉导管,监测中心静脉压(CVP);左侧桡动脉穿刺监测血压。麻醉维持药物为芬太尼15μg/kg及维库溴铵0.1mg/kg。手术开始后,根据心率、血压变化泵入多巴胺3～8μg.kg-1.min-1、硝酸甘油0.1～0.5μg.kg-1.min-1或肾上腺素0.02～0.05μg.kg-1.min-1,维持循环平稳;纠正酸血症,并适当补充人造胶体及新鲜冰冻血浆。结果术后早期患儿的动脉血氧饱和度为(88±6)%,较术前的(69±11)%显著升高(P<0.01)。所有患儿术前肺动脉压力为(13.9±4.3)mmHg(1mmHg=0.133kPa),术后升至(16.8±4.5)mmHg,差异无统计学意义(P>0.05)。术前CVP为(6.4±2.3)cmH2O(1cmH2O=0.098kPa),术后显著升高至(19.3±3.6)cmH2O(P<0.01)。无1例发生并发症和死亡。结论双向Glenn分流术麻醉处理的关键是维持循环平稳,并及时纠正酸血症和低血容量。Objective To retrospectively analyze the anesthesia management for bidirectional Glenn shunt in children with complex cyanotic congenital heart disease. Methods Twenty-four children,aged from 4 months to 14 years,weighing 6-30 kg,were treated with bidirectional Glenn shunt between January 2007 and December 2009.Anesthesia was induced with fentanyl 5-10 μg/kg,vecuronium 0.1-0.15 mg/kg and ketamine 0.1 mg/kg,and maintained by fentanyl 15 μg/kg and vecuronium 0.1 mg/kg.Dual-chamber venous ducts were inserted in the right jugular vein and right femoral vein to measure the central venous pressure（CVP）.The left radial artery was punctured for testing blood pressure.Dopamine 3-8 μg·kg-1·min-1,nitroglycerin 0.1-0.5 μg·kg-1·min-1 or adrenaline 0.02-0.05 μg·kg-1·min-1 were used according to the heart rate and blood pressure when the operation began.The acidosis was corrected in time,and synthetic colloids and fresh frozen plasma were added when needed. Results Arterial oxygen saturation（SaO2） significantly increased from（69±11）% preoperatively to（88±6）% postoperatively（P0.01）.Pulmonary artery pressure increased from（13.9±4.3） mmHg（1 mmHg=0.133 kPa） preoperatively to（16.8±4.5） mmHg postoperatively,but with no statistically significant difference（P0.05）.Postoperative CVP was significantly higher than preoperative one（[19.3±3.6] cmH2O vs.[6.4±2.3] cmH2O,1 cmH2O=0.098 kPa,P0.01）.There was no complication or death. Conclusion Appropriate anesthesia and the stable circulation are important for the success of bidirectional Glenn shunt in children.

关 键 词：双向GLENN手术 紫绀型 先天性心脏病 麻醉处理 

分 类 号：R726.1[医药卫生—儿科]