无脾综合征患儿心脏手术围手术期麻醉管理研究  

Study on perioperative anesthesia management during cardiac surgeryin children with asplenic syndrome

作　　者：彭银俊丞 PENG Yinjuncheng(Department of Anesthesiology,Children′s Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/The Ministry of Education Key Laboratory of Child Development Disease Research/Chongqing Key Laboratory of Structural Birth Defects and Organ Repair and Reconstruction,Chongqing 401122,China)

机构地区：[1]重庆医科大学附属儿童医院麻醉科/国家儿童健康与疾病临床医学研究中心/儿童发育疾病研究教育部重点实验室/结构性出生缺陷与器官修复重建重庆市重点实验室,重庆401122

出　　处：《现代医药卫生》2024年第21期3671-3674,共4页Journal of Modern Medicine & Health

摘　　要：目的探讨无脾综合征患儿心脏手术围手术期麻醉管理要点。方法回顾性选取2013-2023年本院诊断为无脾综合征住院患儿18例,收集患儿临床资料,比较手术患儿入室时、麻醉诱导后、术毕时收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO 2)、中心静脉压(CVP)变化情况。结果18例患儿均至少合并3种以上心脏畸形类别,其中合并3种类别3例(16.7%),合并4种类别8例(44.4%),合并5种类别4例(22.2%),合并6种类别2例(11.1%),合并7种类别1例(5.6%)。18例患儿中,6例接受手术治疗,其中1例先后完成两期手术。7次手术均在体外循环下进行,其中4次手术需要心脏停搏。2例出现术后并发症:1例Fontan术后发生交界性心动过速,1例Glenn术后发生完全性右束支传导阻滞。术后死亡1例。麻醉诱导后、术毕时SBP、DBP、HR、SpO 2水平与入室时比较,差异无统计学意义(P>0.05)。术毕时CVP高于麻醉诱导后,差异有统计学意义(P<0.05)。结论无脾综合征患儿合并心脏畸形情况复杂,能较好地耐受静脉麻醉诱导,术后需要依赖血管活性药物和强心药物支持。Objective To explore the key points of perioperative anesthesia management in children with asplenic syndrome undergoing cardiac surgery.Methods The clinical data of 18 hospitalized children with spleenless syndrome diagnosed in our hospital from 2013 to 2023 were collected retrospectively.The changes of systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),blood oxygen saturation(SpO2),and central venous pressure(CVP)were compared at the time of entering the operating room,after anesthesia induction and at the end of surgery.Results All the 18 children were combined with at least three types of cardiac malformations,including three cases(16.7%)with three types of cardiac malformations,eight cases(44.4%)with four types of cardiac malformations,four cases(22.2%)with five types of cardiac malformations,two cases(11.1%)with six types of cardiac malformations and one case(5.6%)with seven types of cardiac malformations.Of the 18 children,six received surgical treatment,and one of them completed the two-stage operation successively.All seven operations were performed under cardiopulmonary bypass,and four of them required cardiac arrest.Postoperative complications occurred in two cases,including one case of borderline tachycardia after Fontan operation and one case of complete right bundle branch block after Glenn operation.One patient died after operation.There was no significant difference in the levels of SBP,DBP,HR and SpO2 after anesthesia induction and at the end of operation compared with those at the time of entering the operating room(P>0.05).The level of CVP at the end of operation was higher than that after anesthesia induction,and the difference was statistically significant(P<0.05).Conclusion The condition of children with asplenic syndrome complicated with cardiac malformation is complex,but they can tolerate intravenous anesthesia induction well,and need to rely on vasoactive drugs and cardiotonic drugs after surgry.

关 键 词：无脾综合征 围手术期 麻醉 儿童 

分 类 号：R541[医药卫生—心血管疾病]