盐酸戊乙奎醚-氯胺酮-丙泊酚静脉麻醉复合局部浸润麻醉在先天性心脏病封堵术中的应用

目的观察盐酸戊乙奎醚-氯胺酮-丙泊酚静脉麻醉复合局部浸润麻醉方法用于先天性心脏病（CHD）经导管封堵术中的效果。方法选择86例先天性心脏病应用Amplatzer型封堵器经导管封堵术的患儿，随机分为两组：氯胺酮-丙泊酚静脉麻醉复合局部浸润麻醉组（A组）及盐酸戊乙奎醚-氯胺酮-丙泊酚静脉麻醉复合局部浸润麻醉组（B组），每组各43例。结果A组6例（14．0％）患儿术中出现口腔分泌物增多，一度出现轻度上呼吸道梗阻，经吸痰加给氧后缓解；16例（37．2％）患儿在心导管探插或心内操作时出现心律失常；手术时间为（2．65±1．85）h；术毕麻醉苏醒时间为（45．4±15．2）min。B组2例（4．7％）患儿术中出现上呼吸道梗阻，经减轻麻醉后梗阻缓解，与A组比较差异有统计学意义（P〈0．05）；15例（34．9％）患儿在心导管探插或心内操作时出现心律失常；手术时间为（2．58±1．74）h；术毕麻醉苏醒时间为（50．2±17．3）min，后三者与A组比较差异均无统计学意义。结论 盐酸戊乙奎醚-氯胺酮-丙泊酚静脉麻醉复合局部浸润麻醉可安全有效地应用于先天性心脏病经导管封堵术中。

Application of combined penehyclidine hydrochloride-ketamine-propofol intravenous anesthesia with local anesthesia in transca,theter occlusion of congenital heart diseases

Objective To observe the effects of combined penehyclidine hydrochloride-ketamine-propofol intravenous anesthesia with local anesthesia in transcatheter occlusion of congenital heart diseases （CHD）. Methods Eighty-six patients suffered in CHD scheduled for transcatheter Amplatzer occlusio were divided randomly and averagely into two groups with 43 cases each. Group A received combined ketamine-propofol intravenous anesthesia with local anesthesia. Group B received combined hydrochloride-ketamine-propofol intravenous anesthesia with local anesthesia. Results The rate of upper airway obstruction of child patient that was caused by increased oral secretion in group B （4.7%） was significantly lower than that in group A（ 14.0% ） （P 〈 0.05 ）. The upper airway obstruction was removed by aspirating sputum and oxygen therapy in group A, while removed by decreasing anesthetic depth in group B. The rate of arrhythmia in operation, the time of operation and wake-up time were not significantly different between two groups 37.2%,（2.65 ± 1.85）h, （45.4 ± 15.2）min in group A, but 34.9%, （2.58 ± 1.74）h, （50.2 ± 17.3 ）min in group B （P 〉 0.05 ）]. Conclusion The combined penehychdine hydrochlorideke-tamine-propofol intravenous anesthesia with local anesthesia is feasible and safe in transcatheter occlusion of congenital heart diseases.