不同麻醉诱导方法对小儿室间隔缺损修补术中血流动力学影响的对比研究  

Effects of anesthetic induction on hemodynamics in children with ventricular septal defect undergoing cardiac surgery

作　　者：裴馨[1] 韩丁[2] 刘亚光[1] 贾清彦[1] 李稼[3] 欧阳川[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉科,100029 [2]首都儿科研究所附属儿童医院心脏外科 [3]首都儿科研究所临床病理生理研究室

出　　处：《心肺血管病杂志》2015年第10期759-763,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：比较舒芬太尼复合咪达唑仑与七氟烷麻醉诱导,对室间隔缺损修补术患儿血流动力学的影响。方法：择期行室间隔缺损矫治术的1~5岁患儿32例,体质量（12.1±3.1）kg,随机分为静脉组（SM组）和吸入组（S组）。肌注氯胺酮待患儿入睡后,穿刺动脉置管,建立监测。SM组依次给予咪达唑仑-哌库溴铵-舒芬太尼,5分钟肌肉松弛后行气管插管。S组吸入七氟烷,并予哌库溴铵,维持吸入呼末浓度2.0 MAC,5分钟气管插管。使用Mostcare监测仪记录肌注氯胺酮后（T0）、麻醉诱导用药后1分钟（T1）、2分钟（T2）、5分钟（T3）、插管后1分钟（T4）、2分钟（T5）、5分钟（T6）和10分钟（T7）的HR、SBP、DBP、每搏输出量指数（SVI）、心排血量指数（CI）、体循环阻力指数（SVRI）、反映左心室收缩功能的压力升支最大速率（dp/dt）和心动周期效率（CCE）。结果：肌注氯胺酮到诱导后5分钟时间段（T0~T3）：静脉组HR明显下降（P〈0.01）,吸入组HR先下降后上升（P〈0.01）;两组SBP、DBP、CI、SVI、dp/dt及CCE均明显下降（P〈0.01）。CCE组别因素与时间因素存在交互作用（P〈0.05）。诱导后5分钟到插管后,10分钟时间段（T3~T7）：两组HR、SBP、DBP及dp/dt插管后先上升后下降（P〈0.01）,CI、SVI上升（P〈0.01）,SVRI下降（P〈0.01）。两组CCE比较,静脉组高于吸入组（P〈0.05）。结论：1咪达唑仑复合舒芬太尼静脉麻醉与吸入七氟烷的麻醉诱导方法,均能满足心室间隔缺损修补术患儿的麻醉诱导要求,均可维持dp/dt、CI于正常范围,是安全可靠的诱导用药。2舒芬太尼复合咪达唑仑对循环功能影响更轻,可能更适合循环功能低下的患儿。Objective： To compare sufentanil-midazolam with sevoflurane on hemodynamic effects for anesthetic induction in children with ventricular septal defect undergoing cardiac surgery. Methods： 32 chil- dren[from 1 to 5 years old,weight（ 12. 1 ± 3. 1 ）kg] with ventricular septal defect undergoing complete repair surgery were randomly divided into intravenous group （Group SM） and inhalation group （Group S）. After intra- muscular injection of ketamine, puncture radial artery or femoral artery on patients. Midazolam-pipecuronium- sufentanil were given in turn to complete induction of anesthesia in Group SM, while sevoflurane was adjusted to 2.0 MAC and intravenous pipecurouium in Group S. Then intubation 5 rains later. Hemodynamic data recorded by Mostcare included HR, SBP, DBP, SVI, CI, SVRI, the maximal slope of systolic upstroke （dp/dt） and CCE （cardiac cycle efficiency） after injection of ketamine （T0）, 1, 2, 5-min after induction completed （T1, T2, T3, respectively）, and 1, 2, 5 and 10-min after intubation （T4, TS, T6, T7, respectively）. Results： From TO to T3： In Group SM, HR decreased significantly （P 〈 0. 01 ）, in Group S, HR showed a decrease,followed by an increase （P 〈 0. 01 ） ; SBP, DBP, CI, SVI, dp/dt, CCE showed significant decrease （P 〈 0.01 ） in both groups. There existed an interaction effect in CCE between group factor and time factor （P 〈 0.05）. From 33 to T7 ： In both groups, HR, SBP, DBP, dp/dt showed an increase post-intubation, followed by a decrease （P 〈 0. 01 ）, CI and SVI showed increase （ P 〈 0. 01 ）, SVRI showed decrease （ P 〈 0. 01 ） ; CCE were higher in Group SM than that in Group S （ P 〈 0. 05 ）. Conclusion： Intravenous sufentanil-midazo- lam and inhalation of sevoflurane were applicable to anesthetic induction for children with left-to-right shunts undergoing surgery. Sufentanil-midazolam affected hemodynamics less and may be more suitable for children with circulation dysfunction and less tolerant

关 键 词：麻醉诱导 舒芬太尼 咪达唑仑 七氟烷 血流动力学 室间隔缺损 

分 类 号：R54[医药卫生—心血管疾病]