七氟醚吸入诱导麻醉在紫绀型和非紫绀型先天性心脏病婴幼儿中疗效的比较

目的探讨紫绀型和非紫绀型先天性心脏病婴幼儿应用七氟醚吸入诱导麻醉的安全性和有效性。方法选取行择期心脏手术的紫绀型和非紫绀型先天性心脏病患儿各50例。面罩密闭吸入6 L/min纯氧及6%七氟醚诱导麻醉,观察并记录睫毛反射消失时间,记录诱导前(T1),诱导后3 min(T2),诱导后10 min(T3),气管插管后1 min(T4),气管插管后5 min(T5)和气管插管后10 min(T6)时的MAP、HR、SpO2的变化及气管插管条件评分及事件。结果紫绀型先天性心脏病组睫毛反射消失时间[(78.4±26.2)s]明显长于非紫绀型先天性心脏病组[(52.1±19.6)s,P<0.05]。各组内不同时间点及两组间的MAP及HR变化无统计学差异(P>0.05)。紫绀型先天性心脏病组SpO2在T3、T5和T6时点高于T1,紫绀型先天性心脏病组各时点SpO2均低于非紫绀型先天性心脏病组(P<0.05)。两组间气管插管条件评分及气道梗阻发生率比较差异均无统计学意义(P>0.05)。结论紫绀型心脏病患儿七氟醚诱导时间较长,两种类型心脏病患儿实施七氟醚诱导麻醉都具有较好的安全性和插管的良好条件。

Comparison of sevoflurane induction in cyanotic and acyanotic infants with congenital heart disease undergoing cardiac surgeries

Objective To investigate the safety and effectiveness of sevoflurane induction in cyanotic and acyanotic infants with congenital heart disease(CHD)undergoing cardiac surgeries. Methods Fifty infants with cyanotic CHD and fifty with acyanotic CHD were scheduled for cardiac surgeries under 6% sevoflurane for anesthesia induction.The time from mask application to loss of eyelash reflex was recorded.The heart rate,mean arterial pressure(MAP) and oxygen saturation were recorded before induction(T1),3 min(T2),10 min(T3) after induction,1 min(T4),5 min(T5) and 10 min(T6)after intubation.After intubation,intubating conditions were graded and the incidence of airway obstruction was determined. Results The duration of loss of eyelash reflex was found to be longer in cyanotic congenital heart disease patients than that in acyanotic congenital heart disease patients(P<0.05).Heart rate,MAP,the incidences of airway obstruction and intubation conditions were similar between two groups(P>0.05).In addition,oxygen saturation was significantly lower in cyanotic patients than that in acyanotic patients(P<0.01).Oxygen saturation in cyanotic patients at T3,T5 and T6 was significantly higher than that at T1. Conclusion The time of anesthetic induction with sevoflurane in cyanotic infants is longer than that of the acyanotic infants.Sevoflurane induction is an effective and well-tolerated way for cyanotic and acyanotic children with congenital heart disease.