七氟醚用于小儿先天性心脏病手术的临床研究

目的：观察、比较七氟醚吸入麻醉与全凭静脉麻醉在小儿先天性心脏病手术中的应用。方法：40例择期行先天性心脏病房室缺矫治术患儿,随机分为七氟醚组和全凭静脉麻醉组（TIVA组）,每组各20例。七氟醚组患儿以七氟醚吸入诱导,复合小剂量芬太尼、咪达唑仑、维库溴铵,麻醉维持为七氟醚吸入＋芬太尼、维库溴铵;静脉组患儿肌注氯胺酮后,以芬太尼、咪达唑仑、维库溴铵诱导,维持使用丙泊酚持续泵入＋芬太尼、维库溴铵。比较两组术中各时点血流动力学变化、手术麻醉时间与芬太尼、维库溴铵用量、术后呼吸支持时间、清醒时间、拔管时间,比较两组不良反应发生情况。结果：两组患儿均维持比较稳定的血流动力学状态。七氟醚组芬太尼与维库溴铵用量明显低于TIVA组,呼吸支持时间、清醒时间、拔管时间明显低于TIVA组。七氟醚组2例术后发生躁动,3例发生恶心,稍高于TIVA组。结论：七氟醚应用于小儿先心房室缺矫治术,可提供稳定的血流动力学状态,并降低芬太尼与肌松剂用量,实现术后早拔管、改善患者预后、降低医疗费用。

Study on Sevoflurane Anesthesia for Pediatric Patients with Congenital Heart Disease

Objective： To compare the effects of sevoflurane anesthesia with that of total intravenous anesthesia（TIVA） on pediatric patients undergoing cardiac surgeries for congenital heart disease. Methods： 40 children scheduled for atrioseptoplasty or interventricular septum repair were randomly divided into two groups： sevoflurane group （n= 20） and TIVA group （n= 20）. Children in sevoflurane group were inducted with sevoflurane inhalation combined with intravenous injection of low dose of fentanyl, midazolam and vecuronium, while those in TIVA group were induced with intramuscular injection of ketamine combined with intravenous infusion of propofol, fentanyl, midazolam and vecuronium. The hemodynamics at several time points during the surgery were recorded. Then the duration of surgery and the dose of anesthetic were recorded. The time of postoperative respiratory support, emergence and extubation were compared between the two groups. And the adverse reaction during the surgery was also compared. Results： The hemodynamics of the two groups kept a steady state. The doses of fentanyl and vecuronium in sevoflurane group were obviously lower than those in TIVA group（P〈0.05）. The time of postoperative respiratory support, emergence and extubation in sevoflurane group was significantly shorter than that in TIVA group. There were 2 children showed restlessness and 3 children had nausea in sevoflurane group. Conclusion： Sevoflurane anesthesia for pediatric patients with congenital heart disease not only provides a steady hemodynamics, but also decrease the requirements of fentanyl and vecuronium,.. There are some other advantages for sevoflurane anesthesia for pediatric cardiac patients such as earlier extubation, better prognosis and lower cost_