不同麻醉药物在小儿先天性心脏病介入治疗中的应用比较

【目的】观察丙泊酚复合右美托咪定和丙泊酚复合氯胺酮静脉全麻对行先天性心脏病导管封堵术患儿术中血流动力学和术后麻醉恢复时间的影响。【方法】将行先天性心脏病导管封堵术患儿72例，随机分为丙泊酚复合右关托咪定静脉全麻组（A组）和丙泊酚复合氯胺酮静脉全麻（B组），每组各36例。患儿术前均给予阿托品0．01mg／kg，A组患儿静脉注射丙泊酚1．5mg／kg，缓慢注射右美托咪定1．Omg／kg，输注时间超过10min，以诱导麻醉，继以右美托咪定0．5μg／（kg·h）和丙泊酚4～6mg／（kg·h）持续泵入维持，B组丙泊酚用法同A组，诱导时复合使用氯胺酮1．0mg／kg，继以0．5μg／（kg·h）维持。术中常规监测血压、心率、呼吸频率、呼吸幅度、血氧饱和度和心电图变化，以改良Steward苏醒评分评估患儿术后麻醉恢复时间。【结果】两组在心内操作时心率均较麻醉诱导前显著增加（均P〈0．01），但B组较A组更为明显（P〈0．05）。B组麻醉恢复时间显著长于A组，差异有统计学意义（P〈0．01）。【结论】丙泊酚复合右美托咪定静脉全麻下行小儿先天性心脏病介入治疗对操作过程中的心率影响更小，麻醉恢复更快。

Comparison of Different Anesthetics in Pediatric Patients with Congenital Heart Disease Undergoing Cardiac Catheterization

Objective] To compare the effect of propofol in combination with dexmedetomldme vs. propofol in combination with ketamine for intravenous general anesthesia on the hemodynamics and the recovery time of post operative anesthesia in pediatric patients with congenital heart disease undergoing cardiac catheterization. Methods] Seventy-two pediatric patients with congenital heart disease undergoing cardiac catheterization were randomly divided into propofol combined with dexmedetomidine group （group A, n 36） and propofol combined with ketamine group（group B, n = 36）. Before operation, pediatric patients were all given atropine 0.01mg/kg. In group A, anesthesia was induced via intravenous administration of propofol 1.5mg/kg, dexmedetomidine 1.0mg/kg over 10min and maintained with intravenous infusion of dexmedetomidine 0.5μg/（kg · h） and propofol 4 -6mg/（kg ·h）. In group B, patients received the same dose of propofoi and ketamine 1.0mg/kg for induction and maintained with the infusion of ketamine 0.5μg/（kg · h）. During operation, blood pressure, heart rate, respiratory rate, re spiratory amplitude, saturation of blood oxygen and electrocardiogram were monitored. The recovery time of post operative anesthesia in pediatric patients were evaluated by a modified Steward score. Results] Compared with before induction, heart rate was increased significantly in both groups during intracardiac operation（all P 〈0.01）. Heart rate was higher in group B （all P 〈0.01） than that in group B during intracardiac operation（ P 〈0.05）. The recovery time was significantly longer in group B than that in group A, and the difference had statistical significance（ P 〈0.01）. Conclusion] Cardiac catheterization under intravenous general anesthesia with propofol corn bined with dexmedetomidine in pediatric patients with congenital heart disease has minimal effect on the heart rate during operation, and also has rapid recovery time.