先天性肺动脉闭锁小儿心导管及心室造影术的麻醉处理

Anesthesia of children with congenital pulmonary atresia during cardiac catheterization and ventriculography

目的探讨先天性肺动脉闭锁小儿心导管和心室造影术中的麻醉处理。方法2006年1～10月27例先天性肺动脉闭锁行心导管及心室造影小儿。麻醉前常规禁食水,入室后常规监测上下肢血氧饱和度(SpO2)、心电图、袖带血压、面罩吸氧、建立静脉通路。静脉注射氯胺酮1～2mg/kg和东莨菪碱0.02mg/kg施行基础麻醉。如建立静脉通路困难者则先肌注氯胺酮5～8mg/kg+东莨菪碱0.02mg/kg。结果手术基本顺利。其中17例(62.96%)出现不同程度的心律失常、低血压、缺氧、腹胀、呕吐等并发症。死亡1例。结论先天性肺动脉闭锁小儿心内结构复杂,心导管和心室造影麻醉有其特殊性,麻醉医生应该充分掌握该病的病理生理,密切关注手术过程,麻醉前准备充分,给氧充分,保持呼吸道通畅,防止误吸,术后继续吸氧,监测至病儿清醒。

Objective To explore the anesthesia management of children with congenital pulmonary atresia during eardie catheterization and ventrieulography in extra-operation room. Methods Twenty-seven congenital pulmonary atresia children undergoing cardiac catheterization and ventrieulogrphy were selected from January 2006 to October 2006,they were routinely fasting before the procedure, SpO2（both the ann and the leg）and electrocardiogram were monitored and the nonintrodution blood pressure were recorded. Oxygen inhalated by mask and venous route established , they were injected with ketamine （1-2 mg/kg） and seolapamine （0.02 mg/kg） for anesthesia induetion. If it was difficult to establish the venous routes ,we should intromaseular ketamine （5-8 mg/kg） and seolapamine（0.02 mg/kg） firstly,and then established the venous routes. Results The procedures were fufiled steadily. Seventeen patients presented with different kinds of complications such as arrhymia, hypotension, anoxia , abdomen distention and vomitting to different degrees. One child died. Conclusion Congenital pulmonary atresia children＇s hearts structure are very complex. It is important for the anesthesiologists to master the pathophysiology of heart diseases, supply sufficient oxygen, keep airway open and unobstructed,avoid stomach regurgitation and inhalation, after the procedure oxygen should be given continuously, monitors the patients when they are awareness.