新生儿复杂先天性心脏病外科手术麻醉围术期处理  

Anesthesia management strategy for neonate surgery with complex congenital heart disease

作　　者：蒋怡燕 乔彬 吴莉莉 林晓娜 

机构地区：[1]济南军区心血病研究所麻醉科,济南250022

出　　处：《中国体外循环杂志》2012年第2期103-105,共3页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨新生儿复杂先天性心脏病外科手术麻醉围术期处理策略。方法 85例患者体重1.9～5(3.45)kg。右肺动脉起源主动脉并室间隔缺损(VSD)2例,降主动脉缩窄并VSD、动脉导管未闭(PDA)8例,主动脉弓离断并VSD+PDA6例,VSD合并房间隔缺损(ASD)+PDA 20例,右室双出口8例,完全性大动脉错位21例,肺动脉近似闭锁法洛四联症9例,完全性肺静脉异位引流11例。患儿术前30 min口服咪唑安定0.5 mg/kg,东茛菪碱0.02～0.04 mg/kg肌注。有心衰者给予静脉持续输注多巴胺3～5μg/(kg.min)。大血管错位/室间隔完整者不吸入高氧,并给予前列腺素E1 5～10 ng/(kg.min),持续输注直至建立体外循环。患儿入手术室后开放外周静脉,监测心电图、脉搏血氧饱和度和无创血压。以芬太尼5μg/kg,维库溴铵0.1 mg/kg静注诱导,经鼻气管内插管,压力控制模式(PCV)进行机械呼吸,采用静吸复合方法维持麻醉,术中连续监测动脉压、中心静脉压、血气、电解质、血糖、乳酸和心排量,并给予及时纠正。重度肺动脉高压术后压力下降不满意者吸入伊洛前列素,心脏复跳后有房室传导阻滞者置入左心室临时起搏器。结果 85例麻醉成功行动、静脉穿剌置管术建立术中监测及血管通道,麻醉效果满意,术后6～8 h麻醉清醒,24～72 h脱离呼吸机。没有出现由麻醉引起的术中血流动力学明显改变和并发症。2例因严重低心排,心力衰竭,经抢救无效于第2 d死亡。2例大动脉错位因冠状动脉畸形,术后吻合口出血,心功能不全当天死亡。结论新生儿麻醉处理策略要从其生理和解剖特点出发,把握其麻醉特点对开展新生儿复杂心血管手术安全是有保障的。Objective To investigate anesthesia management strategy for neonate surgery with complex congenital heart disease（CHD）.Methods 85 cases weight of 1.9-4.5 kg（mean of 3.45 kg）.The diagnosis of these neonates included 2 cases of abnormal right pulmonary artery origin with ventricular septal defect（VSD）,8 cases of aortic coarctation（CoA） with VSD and patent dustus arteriosus（PDA）,6 cases of interrupted aortic arch（IAA） with VSD and PDA,20 cases of VSD with atrial septal defect（ASD） and PDA,8 cases of double-outlet right ventricle（DORV）,21 cases of complete transposition of great arteries（TGA）,9 cases of tetralogy of Fallot（TOF） with pulmonary atresia and 11 cases of total anomalous pulmonary venous connection（TAPVC） were included.The patients were given midazolam 0.5 mg/kg by oral and scopolamine 0.02-0.04 mg/kg by intramuscular 30 min before the operation.Dopamine 3-5 μg/（kg·min） was infused persistently if heart failure happened before the operation.The patients with great vessels complete transposition and with an intact ventricular septum were dealing without high O2 and prostaglandin E1（PGE1） 5-10 ng/（kg·min） was given persistently until extracorporeal circulation begin.Periphery vein was opened and the ECG,SpO2 and non-invasive blood pressure were monitored after the patient entered the operation room.Fentanyl 5 μg/kg and vecuronium 0.1 mg/kg were applied for anesthesia induction and all the patients were transnose tracheal intubated with pressure control ventilation.Intravenous-inhalation combined anesthesia maintenance was adopted.The arterial pressure,central venous pressure,gas analysis,electrolyte analysis,glucose,lactic acid and cardiac output（CO） were monitored continuously and corrected in time during the operation.The iloprost solution was inhaled to reduce pulmonary hypertension（PH） if the pressure declined unsatisfied after the surgery.Interim pacemaker was placed to maintain normal heart rate if heart block happened.Results The anes

关 键 词：新生儿 复杂先天性心脏病 围术期 麻醉处理策略 

分 类 号：R726.1[医药卫生—儿科]