非发绀型先天性心脏病MSCT检查前行麻醉处理的临床应用价值分析

目的旨在探讨非发绀型先天性心脏病多层螺旋CT(MSCT)检查前行麻醉处理的临床应用价值。方法将2017年1月至2018年8月我院64例非发绀型先天性心脏病采用麻醉处理行MSCT检查患儿的临床资料进行回顾性分析,密切监测和记录所有患儿其MSCT检查和麻醉情况。结果 64例患儿在检查中出现心率减慢、血压下降、血氧饱和度下降、喉痉挛、检查后高热和室性期前收缩分别为13例、6例、16例、5例、5例和4例,其中动脉导管未闭血氧饱和度下降率最高。64例患儿均完成了CT检查,58例患儿注入丙泊酚(1.5-2. 0mg/kg)后1次即完成检查,6例患儿再次追加丙泊酚用量(0.5-0.6mg/kg)完成检查。在MSCT检查中,房间隔缺损表现为右心房、右心室明显增大,肺动脉可见增宽,进一步增强示房间隔连续中断;室间隔缺损平检查可示:室间隔中断,以不连续性呈现,心室以不同程度增大显示,肺血管可见明显增粗、增多;动脉导管未闭可明显显示动脉导管较大且未闭合,左心室增大;肺动脉缩窄可表现为肺动脉瓣膜明显增厚,开放受限,主肺动脉干狭窄后扩张;而法洛四联症以肺动脉狭窄、室间隔缺损、主动脉骑跨和右心室肥厚为其主要表现,部分可见肌小梁粗大致腔内充盈缺损。结论非发绀型先天性心脏病患儿术前进行丙泊酚注射麻醉后均可完成MSCT检查,而检查中密切监测患儿生命体征对保障患儿安全尤为重要,MSCT清晰显示的影响图像有利于指导临床制定合适的手术治疗方案。

Clinical Application Value of Multi-slice Spiral CT(MSCT) for Examining Preoperative Anesthesia in Patients with Non-cyanotic Congenital Heart Disease

Objective To investigate the clinical application value of multi-slice spiral CT(MSCT) for examining preoperative anesthesia in patients with non-cyanotic congenital heart disease. Methods 64 patients with non-cyanotic congenital heart disease treated in our hospital from January 2017 to August 2018 were anesthetized and subjected to MSCT examination. The clinical data of the children were retrospectively analyzed. All patients were closely monitored and recorded for MSCT and anesthesia. Results In 64 children, there were 13 cases whose heart rate slowed down, 6 cases whose blood pressure decreased, 16 cases whose oxygen saturation decreased, 5 cases who had laryngeal spasm, 5 cases who had high fever and 4 cases whose ventricular premature contraction. Among them, droop rate of oxygen saturation in patent ductus arteriosus was the highest.All the 64 patients underwent CT examination. 58 patients were injected with propofol(1.5-2.0 mg/kg) to complete the examination once, and 6 patients were given propofol again(0.5-0.6 mg/kg) to complete the examination. In the MSCT examination, the atrial septal defect showed significant increase in the right atrium and right ventricle, and widening of the pulmonary artery, and the continuous interruption of atrial septum after further enhancement.The examination for ventricular septal defect can show that the interventricular septum was interrupted and presented with discontinuity. The ventricles were increased in different degrees, and the pulmonary vessels were obviously thickened and increased. The patent ductus arteriosus can clearly show that the arterial catheter was large and not closed. The left ventricle was enlarged. Constriction pulmonary artery showed significant thickening of the pulmonary valve and limited opening.the main pulmonary artery was narrowed and then expanded. The tetralogy of Fallot was mainly characterized by pulmonary stenosis, ventricular septal defect, aorta saddle and right ventricular hypertrophy,some showed that trabecular thickening resulted in defect of intraluminal filling. Conclusion MSCT can be completed after preoperative anesthesia with propofol injection in children with noncyanotic congenital heart disease. It is especially important to closely monitor the vital signs of children during the examination to ensure the safety of children. The image clearly displayed by MSCT is useful to guide the doctor to development appropriate surgical treatment in clinic.