快通道麻醉方法应用于婴儿先心病矫治术60例

目的　观察快通道麻醉方法在婴儿先心病矫治手术中的应用 .方法　 6 0例 (年龄 1mo～ 1a)拟接受先心病矫治手术的患儿 ,均采用小剂量芬太尼 -异氟醚复合麻醉 .观察围术期循环指标的变化及麻醉用药情况 ,患者术毕苏醒及拔管时间 ,术后转归等 .结果　所有患儿的平均动脉压、心率及中心静脉压在诱导后、手术开始前、劈胸骨后、转机前、停机后、手术结束时、入 ICU后均没有显著改变 .6 0例患儿中有 16例术后拔管时间小于或等于 3h,其 ICU监护时间为 (4 0±12 ) h;另有 30例患儿术后拔管时间在 3～ 18h之间 ,其 ICU监护时间 (6 9± 36 ) h明显延长 (与小于或等于 3h组比较 ,P<0 .0 5 ) ;其余 14例患儿术后拔管时间大于 18h,其 ICU监护时间 (147± 90 ) h进一步延长 (与前两组比较 ,P<0 .0 1) .结论　小剂量芬太尼 -异氟醚复合麻醉可以应用于婴儿先心病矫治手术 ,能在围术期维持循环稳定 ,为手术创造良好条件 ,有利于尽早拔管 ,并使缩短 ICU监护时间成为可能

Application of fast-track cardiac anesthesia to scheduled corrective operation of congenital heart diseases

AIM To evaluate the feasibility of fast-track cardiac anesthesiaapplied to the patients undergoing scheduled corrective operation of congenital heart diseases (CHD). METHODS 17 patients scheduled for corrective operation of CHD under combined anesthesia with a small-dose-fentanyl and isoflurane were studied. Cardiovascular parameters, usage of anesthetics, postoperative recovery and extubation time were observed. RESULTS Mean arterial blood pressure, heart rate and central venous pressure had no significant changes among postinduction, pre-operation, post-sternotomy, before extracorporal bypass, after extracorporal bypass, end of operation and after arriving ICU in all patients (P>0.05 when compared with each other). Of 60 patients, there were 16 ones with extubation time ≤3 hours, whose stay in ICU was 40±12 hours; and 30 ones with extubation time >3 hours but ≤18 hours, had longer ICU stay (69±36 hours) than that in patients with extubation time ≤3 hours (P<0.05); the remaining 14 ones with extubation time >18 hours, had ICU stay of 147±90 hours, which was longer than that of the former two groups (P<0.01). CONCLUSION Fast-track cardiac anesthesia with combined anesthesia of a small-dose-fentanyl and isoflurane could be applied to children (≤1 years) undergoing CHD corrective operation, which could provide stable cardiovascular status during the period of anesthesia and operation, and facilitate earlier extubation and earlier discharge from ICU after operation.