硝普钠对婴幼儿心脏手术复温与心脏复跳时间的影响

Effects of Sodium Nitroprusside on the Time of Rewarming and Cardioversion during Heart Operations in Children up to Three Years of Age

目的观察硝普钠对婴幼儿心脏手术复温和心脏复跳时间的影响。方法将56例心功能为Ⅱ～Ⅲ级、须行择期畸形矫治术的先天性心脏病婴幼儿随机分为硝普钠组36例和对照组20例。所有患儿均静脉注射咪达唑仑（0．15mg·kg^-1）、芬太尼（2μg·kg^-1）和泮库溴铵（0.1mg·kg^-1）行麻醉诱导，间断静脉注射芬太尼（10μg·kg^-1）和泮库溴铵（0．1mg·kg^-1）雏持麻醉。当心内手术操作进行2／3时开始全身复温，鼻咽温度升至36．5～37.0℃或肛温升至35．0～36.0℃。硝普钠组复温开始时从中心静脉用Grasby微量泵持续输注硝普钠，0．2～6．5μg·kg^-1·min^-1。所有患儿维持平均动脉压40-50mmHg（1mmHg=0．133kPa）。主动脉开放5min后心脏不能自主复跳或异常心率不能转为窭性心律则行电击复跳。记录复温开始至复温终止时间（t1）、主动脉开放至出现窭性心律的时间（t2）和复温开始至窦性心率出现所用硝普钠量（Q）。结果硝普钠组t1和t2值均较对照组显著减小（均P〈0．01），Q与t1、t2均呈负相关（均P〈0．01），t1与f2呈正相关（P〈0．01）。结论婴幼儿心脏手术时合理应用硝普钠有利于缩短复温时间．并可促使心脏尽快自动复跳。

Objective To study the effects of sodium nitroprnsside on the time of rewarming and cardioversion during heart operations in children up to three years of age. Methods 56 children suffering from congenital heart diseases and scheduled for corrective therapy of the deformities were randomly divided into 2 groups ： the sodium nitropruside group （ n=36） and the control group （n =20）. These children up to 3 years of age had a cardiac function of Grade Ⅱto Grade Ⅲ. Systemic rewarming was begun at the time when 2/3 of the work of operation had been completed and the nasopharyngeal temperature and rectal temperature gradually rose to 36, 5 - 37℃ and 35 - 36℃, respectively. Beginning from the starting of rewarming, patients of the sodium nitroprasside group was given each sodium nitroprusside （0.2 -6.5μg·kg^-1·min^-1） administered continuously via the central vain with a Grasly mieropump. The mean arterial blood pressure in all patients were maintained within the range of 40 - 50 mmHg. All of the patients were subjected to extracorporeal circulation while endotracheal intubation was used to control respiration. The patients were given each IV injections of midazolam （ 0. 15 mg·kg^-1）, fentanyl （ 20μg·kg^-1） and pancuronium bromide （0. 1 mg·kg^-1） for anesthesia induction and disconnected IV injections of fcntanyl （ 10μg·kg^-1） and pancuronium bromide （0.1 mg·kg^-1） for maintenance anesthesia. Electric eardioversion was carried out of no spontaneous heartbeat took place or cardiac arrhythmias could not be converted to sinus rhythm 5 min after the deelamping of the aorta. The time from the beginning to the termination of rewarming （ t1） and that from declamping the aorta to the restoration of sinus rhythm （ t2 ）, as well as quantity of sodium nitroprusside used from the beginning of rewarming to the reappearance of sinus rhythm （Q） were noted dora. Results The value of t l and t2 in patients of the sodium nutroprusside group were significantly smaller than those in patients of the control group （P 〈0.01 ）. The value of 0 in patients of the sodium nitroprusside group was negatively correlated with t1 and t2 （ P 〈 0.01 ） while the value of t1 was positively correlated with t2 in these patients （ P 〈 0.01 ）. Conclusion Proper use of sodium nitroprusside during heart operations in young children was shown to shorten the time of rewarming and promote restoration of sinus rhythm.