小儿双向Glenn手术的麻醉体会

目的总结复杂性先天心患儿在非体外循环下行双向Glenn术的麻醉管理。方法16例患儿在非体外循环下行双向Glenn术。所有患儿采用静吸复合麻醉方法。麻醉维持主要采用中小剂量的舒芬太尼或芬太尼。并辅以低浓度的七氟醚吸人。结果术毕SpO2、CVP较术前显著升高（P〈0．01）,而术毕Hb及Hct较术前显著降低（P〈0．05）。术后早期均有不同程度的眼睑、面部水肿症状,6例出现全身抽搐等脑缺氧表现,1例术后出现痴呆。除了两例术后早期患儿因低心排血量综合征合并肾功能衰竭而死亡外,患儿术后紫绀症状明显改善。无麻醉并发症。结论在恰当的麻醉方式下,维护心血管功能稳定．维持较高水平的腔静脉压力并降低肺血管阻力以促进肺血流的改善,调控内环境平衡并加强脑保护等是麻醉管理的关键。

Anesthetic experience of bidirectional Glenn shunt procedure in children

Objective To investigate the anesthesia management of bidirectional Glenn shunt without cardiopulmonary bypass （CPB） for complex congenital heart diseases in children. Methods Sixteen children underwent bidirectional Glenn shunt without CPB. Combined anesthesia was used for all the children.Anesthesia was maintained with intravenous small or middle dose of fentanyl or sulfentanil and supplemented with low concentration of sevoflurane inhalation. Results The mean SpO2 and CVP were significantly increased（P〈0.01）, while Hb and Hct were significantly decreased at the end of operation in comparison with preoperation （P〈0.05）. The eyelids and face oedema occurred in all children at early afteroperation, and convulsion for cerebral hypoxia occurred in six cases. Dementia occurred in one case. There were two early postoperative deaths due to low cardiac output syndrome associated with renal failure. The cyanosis was significantly improved. There was no anesthetic complications. Conclusion It is the key factors to anesthetic management ,including maintained stable cardiac vascular function,improved pulmonary blood flow,controlled internal environment balance and enhanced cerebral protection.