FloTrac/Vigileo监测右美托咪定滴鼻复合七氟醚吸入诱导对先天性心脏病患儿血流动力学的影响  

Effects of anesthesia induction by dexmedetomidine nasal inhalation combined with sevoflurane inhalation on hemodynamics in children with congenital heart disease by Flo Trac/Vigileo monitoring

作　　者：谭卫华[1] 曾慧 刘健萍 毛丙荣[1] TAN Weihua;ZENG Hui;LIU Jianping;MAO Bingrong(Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine,Nanning 530011,Guangxi,China)

机构地区：[1]广西中医药大学附属瑞康医院,广西南宁530011

出　　处：《现代中西医结合杂志》2018年第31期3426-3429,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20170755)

摘　　要：目的通过Flo Trac/Vigileo心排量监测仪的动脉波形分析计算心排血量技术(APCO),观察右美托咪定滴鼻复合七氟醚吸入对先天性心脏病(先心病)患儿血流动力学的影响,探讨更适合于先心病患儿的麻醉诱导方法。方法将60例行室间隔缺损修补术患儿随机分为3组,麻醉诱导前,右美组20例给予右美托咪定滴鼻复合七氟醚吸入,七氟醚组20例给予七氟醚吸入,氯胺酮组20例给予氯胺酮肌注,患儿体动反应消失后给予咪达唑仑、维库溴铵、舒芬太尼和依托咪酯进行麻醉诱导,5 min后行气管内插管,给予机械通气。麻醉过程中均采用Flo Trac/Vigileo心排量监测仪监测血流动力学。结果右美组基础麻醉时(t0),麻醉诱导后1 min(t1)、2 min(t2)、5 min(t3)和插管后1 min(t4)、5 min(t5)、10 min(t6)时心率(HR)、平均动脉压(MAP)、每搏量(SV)、心指数(CI)比较差异均无统计学意义(P均>0. 05),各时点每搏指数(SVI)、心排血量(CO)比较差异均有统计学意义(P均<0. 05);七氟醚组、氯胺酮组上述各时点HR、MAP、SV、SVI、CI、CO比较差异均有统计学意义(P均<0. 05)。右美组t0～t6时点HR均明显低于七氟醚组、氯胺酮组(P均<0. 05),七氟醚组各时点HR均低于氯胺酮组(P均<0. 05);右美组t0、t1、t2时点MAP、SV均明显低于氯胺酮组(P均<0. 05)。右美组t0时点CI、CO明显低于氯胺酮组(P均<0. 05),t1、t2、t4时点CI和t4时点CO均明显高于氯胺酮组(P均<0. 05)。右美组t1～t6时点SVI均明显高于氯胺酮组(P均<0. 05)。结论右美托咪定滴鼻复合七氟醚麻醉吸入更适合于先心病患儿手术麻醉诱导,Flo Trac/Vigileo心排量监测仪可动态监测先心病患儿麻醉期间血流动力学变化,且微创、简单。Objective It is to calculate the cardiac output(APCO)by analyzing the arterial waveform of FloTrac/Vigileo cardiac output monitor,to observe the effects of anesthesia induction by dexmedetomidine nasal inhalation combined with sevoflurane inhalation on hemodynamics in children with congenital heart disease,thus to fine more suitable anesthesia induction for children with congenital heart disease.Methods Sixty patients undergoing ventricular septal defect repair were randomly divided into three groups.Before anesthesia induction,20 patients in the dexmedetomidine group were given dexmedetomidine nasal inhalation combined with sevoflurane inhalation,and 20 patients in the sevoflurane group were given heptafluoro inhalation,20 patients in ketamine group were given intramuscular injection of ketamine.After the body motion disappeared,midazolam,vecuronium bromide,sufentanil and etomidate were given for anesthesia induction.After 5 minutes,endotracheal intubation was performed to use mechanical ventilation.Hemodynamics was monitored using an FloTrac/Vigileo cardiac displacement monitor during anesthesia.Results In the dexmedetomidine group,there was no significant difference in heart rate(HR),mean arterial pressure(MAP),stroke volume(SV),and heart index(CI)at the time of basic anesthesia(t 0),at 1 min(t 1),2 min(t 2),5 min(t 3)after anesthesia induction,and 1 min(t 4),5 min(t 5),and 10 min(t 6)after endotracheal intubation,but the differences in stroke index(SVI)and cardiac output at each time point were statistically significant(P<0.05).There were significant differences in HR,MAP,SV,SVI,CI and CO at each time point in the sevoflurane group and the ketamine group(P<0.05).The HR of the dexmedetomidine group at t 0,t 1,t 2,t 3,t 4,t 5,t 6 was significantly lower than that of the sevoflurane group and the ketamine group(P<0.05),and the HR at each time point of the sevoflurane group was lower than the ketamine group(P<0.05);MAP,SV at the time of t 0,t 1,and t 2 in the dexmedetomidine group were significantly lower than th

关 键 词：右美托咪定滴鼻 七氟醚 麻醉诱导 先天性心脏病 血流动力学 

分 类 号：R614.2[医药卫生—麻醉学]