七氟醚复合亚剂量氯胺酮麻醉诱导用于重症先天性心脏病患儿心脏手术

Sevoflurane Combined with Sub-dose Ketamine Anesthesia Induction in High-risk Surgical Children with Congenital Heart Disease

目的:观察七氟醚复合亚剂量氯胺酮麻醉诱导用于重症先天性心脏病患儿心脏手术的临床效果。方法:选择重症先天性心脏病患儿30例,年龄1～4岁。将患儿随机分成三组(n=10):氯胺酮肌注诱导组(K组)、七氟醚吸入诱导组(S组)和七氟醚吸入复合亚剂量氯胺酮肌注诱导组(SK组)。观察诱导过程中ECG、BP、SpO2和HR,及各组患儿哭闹时间、睫毛反射消失时间、疼痛反射消失时间,患儿有无躁动、呛咳、喉痉挛、严重缺氧等,插管时应激反应情况。结果:K组诱导过程中患儿哭闹时间、睫毛反射消失时间和疼痛反射消失时间长,且躁动和缺氧严重,易发生快室率心律失常和严重低血压;与K组比较,S组循环稳定,无严重缺氧和低血压发生(P<0.01),但患儿哭闹时间、睫毛反射消失时间和疼痛反射消失时间无显著差异且躁动明显(P>0.01);SK组循环稳定,无明显躁动、严重缺氧和低血压发生(P<0.01)。结论:七氟醚复合氯胺酮用于重症先天性心脏病患儿心脏手术麻醉诱导对循环干扰小,诱导过程平稳安全且患儿易接受,是该类患儿的较理想麻醉诱导方法。

Objective To investigate the clinical effect of sevoflurane combined with sub-dose ketamine anesthesia induction in high-risk surgical children with congenital heart disease.Methods Thirty high-risk surgical children with congenital heart disease(13 male,17 female) undergoing open heart surgery aged from 1-4 years were randomly divided into three groups:(1)ketamine intramscular injection group(K),(2) sevoflurance inhalation group(S),(3) sevoflurance combined ketamine induction group(SK).Using of multi-function monitoring of ECG,BP,SpO2,HR and arterial blood pressure,and observing cyanosis,laryngospasm,body movement,crying time,eyelash reflex time,pain reflex time,dangerous situations(arrhythmia,cardiac arrest) and intubation reaction during anesthesia induction.Results The children's crying time,loss of eyelash reflex time and pain reflex time were long,and there existed more body movement,severe hypoxia,rapid ventricular rhythm arrhythmias and severe hypotension during induction in group K.There was stable hemodynamics,no severe hypoxia and hypotension(P<0.01),there was no significant difference in crying time,eyelash reflex time and pain reflex time and body movement was more obvious in S group compared with group K(P>0.01);there existed hemodynamics stability,no obvious restlessness,severe hypoxia and hypotension in group SK compared with group K and S(P<0.01).Conclusion Sevoflurane combined ketamine induction on children with severe congenital heart diseases has less circulatory disturbances,more smooth process and is easier to be accepted,and this is an ideal method of anesthesia induction in children.