先天性心脏病小儿七氟醚和安氟醚肺摄取和排出的临床研究

Uptake and Elimination of the Lungs for Sevoflurane or Enflurane in Children with Congenital Heart Disease:A Clinical Study

本文观察了43例先心病小儿肺对七氟醚或安氟醚摄取(Fa/Fi)和排出(Fa/Fao)的情况。结果Fa/Fi值和Fa/Fao值曲线经拟合证明符合对数方程形式LgFa/Fi(Fa/Fao)=A±Bt(r=0.86～0.99,P<0.01),七氟醚发绀组的t4/5Fa/Fi(Fa/Fi=0.8)值明显小于安氟醚发绀组(P<0.05),与Fa/Fi值的变化一致,但曲线斜率B值无统计学差异(P>0.05),安氟醚非发绀组和七氟醚发绀组的t1/2Fa/Fao(Fa/Fao=0.5)值明显高于七氟醚非发绀组(P<0.05),其斜率负B值差异显著(P<0.05),与Fa/Fao值的变化一致。表明影响先心病小儿肺摄取和排出的因素比较复杂,其病理生理特点(如心内分流)可能改变吸入麻醉药的药代动力学。

Forty-three children with congenital heart disease scheduled for cardiac surgery were studied to determine up-take(Fa/Fi) and elimination (Fa/Fao) in the lungs for sevoflurane or enflurane. The results indicate that the change of Fa/Fi and Fa/Fao with time fitted the equation LgFa/Fi(Fa/Fao)=A盉t(r = 0. 86-0. 99,P<0. 01). The value of tFa/Fi(Fa/Fi = 0. 8) in cyanotic group of sevoflurane was significantly(P<0. 05) shorter than that in cyanotic group of enflurane .similar with the change of Fa/Fi. The value of tFa /Fao (Fa /Fao= 0. 5) in cyanotic group of sevoflurane and acyanotic group of enflurane was significantly (P<0. 05)longer than that in cyanotic group of sevoflurane, keeping with the change of Fa/Fao, same as the slope differences. The study suggests that factors which alter uptake and elimination of the lungs for inhalation anesthetics in children with congenital heart disease are very complicated. The pharmacokinetics of inhalation anesthetics may be influenced by patients' patthological changes,such as intracardiac shunt.