重症先天性心脏病患儿心导管及造影检查时的麻醉——369例总结  

Anesthesia of Children with Grave Congenital Heart Diseases during Cardiac Catheterization and Ventriculography——369 Cases Review

作　　者：王云[1] 张东亚[1] 黄维勤[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院麻醉科,北京市100037

出　　处：《中国循环杂志》2001年第1期56-57,共2页Chinese Circulation Journal

摘　　要：目的 :介绍小儿重症先天性心脏病 (先心病 )患儿心导管及造影检查时的麻醉体会。　　方法 :选择 36 9例先心病施行心导管或左右心室造影检查的患儿 ,其中左向右分流合并重度肺动脉高压 86例 ,肺动脉瓣狭窄和原发性肺动脉高压 11例 ,右向左分流复杂畸形 2 72例。麻醉前常规禁食。入室后监测外周血氧饱和度、心电图及血压 ,记录基础值。患儿面罩吸氧 ,建立静脉通路后 ,静脉注射东莨菪碱 0 .0 2 mg/ kg、氯胺酮 1～ 2 mg/ kg。待患儿意识消失后肌肉注射氯胺酮 6～ 8mg/ kg+氟哌啶 0 .15～ 0 .30 mg/ kg维持 ,或间断静脉注射氯胺酮 1～ 2 mg/ kg加深麻醉。　　结果 :术中经过基本顺利。全组共 18例出现不同程度腹胀、呕吐、呛咳、心律失常、顽固性缺氧等并发症 ,发生率4.88% ,其中 1例死亡 ,死亡率 0 .2 7%。　　结论 :小儿重症先心病行心导管及心血管造影检查时 ,麻醉有其特殊性。要求麻醉医师掌握心脏病的病理生理 ,充分给氧 ,保持呼吸道通畅 ,防止胃返流、误吸的发生 ,充分镇静 ,术后继续吸氧并监测血氧饱和度 ,尽可能避免并发症的发生。Objective:To introduce our experience on extra operating room anesthesia of children with grave congenital heart diseases during cardiac catheterization and ventriculography. Methods:Three hundred and sixty nine children with grave congenital heart diseases undergoing cardiac catheterization or ventriculography were selected for this study,among whom 86 are presented with left to right shunt and pulmonary artery hypertention,11 with pulmonic stenosis and primary pulmonary artery hypertention,and 272 with right to left shunt.They were routinely fasted before the procedure.O 2 Saturation(SpO 2) and electrocardiogram were monitored and blood pressure were recorded.With oxygen inhalated by mask and venous route established,the children were injected with scolapamine (0 02 mg/kg) and ketamine (1 2 mg/kg) for anesthesia induction.When patients lost conciousness,ketamine (6 8 mg/kg) and droperidol (0 15 0 30 mg/kg) were given intromascularly for maintainence.During the procedure,ketamine (1 2 mg/kg) were given to deepen anethesia. Results:The procedures were fufiled steadily.Eighteen patients presented with different kinds of complications such as abdomen distention,vomitting,arrhymia and refractory anoxia to defferent degrees.One patient died,and the mortality was 0 27%. Conclusions:Anesthesia of children with grave heart diseases during cardiac catheterization and ventriculography is particular.It is important for the anesthesiologists to be familiar with the pathophysiology of heart diseases,and supply sufficiant oxygen,keep airway open and unobstructed,avoid stomach regurgitation and inhalation and maintain sufficient sedation during the procedure.Oxygen should be given continuously and SpO 2 monitored posoperatively to avoid any complication.

关 键 词：复杂先天性心脏病 麻醉 心导管检查 造影检查 儿童 

分 类 号：R541.1[医药卫生—心血管疾病] R540.46[医药卫生—内科学]