单纯超声引导下先天性心脏病经皮介入治疗的麻醉管理  

Anesthesia management in percutaneous interventional procedures of congenital heart diseases under echocardiography guidance without fluoroscopy

作　　者：张喆[1] 晏馥霞[1] 欧阳文斌[2] 于钦军[1] 

机构地区：[1]中国医学科学院,北京协和医学院,阜外医院麻醉科,国家心血管病中心,心血管疾病国家重点实验室,北京100037 [2]中国医学科学院,北京协和医学院,阜外医院心外科,国家心血管病中心,心血管疾病国家重点实验室,北京100037

出　　处：《中国医药导报》2016年第16期62-65,共4页China Medical Herald

基　　金：北京市科学技术委员会计划项目--首都临床特色应用研究(Z131107002213079)

摘　　要：目的 探讨单纯超声引导下先天性心脏病经皮介入治疗的麻醉管理策略。方法 调取2014年9月～2015年6月在中国医学科学院阜外医院接受单纯超声引导下先天性心脏病经皮介入治疗患者的病历资料,收集患者的性别、年龄、体重、疾病诊断、介入术时长以及麻醉管理相关数据。结果 入选患者93例。动脉导管未闭[（3±1）岁]和肺动脉瓣狭窄[（3±2）岁]患者的年龄明显低于房、室间隔缺损患者[（15±17）、（10±8）岁）]。室间隔缺损介入术的时长[（105±36）min]明显长于房间隔缺损[（39±13）min]、动脉导管未闭[（47±11）min]和肺动脉瓣狭窄[（46±11）min]介入术的时长。73例小儿患者（≤12岁）中,33例（45.2%）使用喉罩、在局麻加静吸复合麻醉下行经皮介入治疗,其余40例（54.8%）在局麻加静脉麻醉下行经皮介入治疗。20例青少年和成人患者（〉12岁）均在局麻加静脉麻醉下行经皮介入治疗。93例患者在介入治疗术中均保留自主呼吸。氯胺酮适用于小儿,尤其是婴幼儿患者,但肺动脉瓣狭窄的患者应谨慎使用。丙泊酚适用于3岁以上患者。咪达唑仑、右美托咪定和七氟烷适用于各种年龄和疾病类型的患者。3例（3.2%）患者经皮介入治疗未成功,转而在机械通气下实施开胸手术。93例患者围术期均未出现麻醉相关并发症。结论 应根据患者年龄、疾病诊断以及经皮介入治疗术的复杂程度“个体化”选择麻醉方式和使用麻醉药物。Objective To discuss the anesthesia management in percutaneous interventional procedures of congenital heart diseases under echocardiography guidance without fluoroscopy. Methods Medical records of patients with congenital heart diseases undergoing percutaneous interventional procedures under echocardiography guidance without fluoroscopy in Fuwai Hospital from September 2014 to June 2015 were selected. The data of sex, age, weight, disease diagnosis, intervention operation duration and anesthesia management were extracted. Results 93 cases of patients were included. The age of patients with patent ductus arteriosus [（31） years] and pulmonary valve stenosis [（3±2） years] were less than that of patients with atrial septal defect and ventricular septal defect [（15±17）, （10±8） years] significantly. The duration of interventional procedures of ventricular septal defect [（105±36） min] was longer than that of atrial septal defect [（39±13） min], patent ductus arteriosus [（47±11） min], and pulmonary valve stenosis [（46±11） mini. In 73 pediatric patients （≤ 12 years）, 33 of them （45.2%） were underwent local-intravenous-inhalation combined anesthesia using the laryngeal mask, while the remaining 40 cases （54.8%） were underwent local-intravenous combined anesthesia. 20 adolescent and adult patients （〉12 years） were all underwent local-intravenous combined anesthesia. All of the 93 patients had spontaneous respiration during inter- ventional procedures. Ketamine was suitable for pediatric patients, especially for infants, but should be used with cau- tion in patients with pulmonary yalve stenosis. Propofol was suitable for patients more than 3 years old. Dexmedetomidine, Midazolam and Sevoflurane were suitable for patients with various ages and diseases. 3 patients （3.2%） were received mechanical ventilation and open chest surgery for the failure of interventional procedure. No anesthesia related periop- erative complication was occurred in the 93 patients. Conclu

关 键 词：超声引导 先天性心脏病 经皮介入术 麻醉管理 

分 类 号：R614.2[医药卫生—麻醉学]