婴幼儿心内直视手术的麻醉处理

Anaesthesia in intracardiac operation underdirect vision of infants

目的回顾总结74例10kg以下婴幼儿先天性心脏病行心内直视手术麻醉处理。方法对我院2007年2月～2008年6月的82例10kg以下婴幼儿先心病手术的临床资料(年龄、性别、体重、手术类型等)及麻醉方法做一回顾性分析其中8例因资料不全放弃。全组病例男38例,女36例。年龄8～36个月,体重5.5～10kg。入室前由家长陪同,肌肉注射氯胺酮行基础麻醉,入室后建立监测,咪唑安定、维库溴铵、芬太尼诱导,诱导后经鼻明视行气管内插管行间歇正压通气。间断给予芬太尼、维库溴铵、持续丙泊酚泵入维持麻醉。术中连续监测ECG、MAP、CVP、SpO2、PETCO2、SVO2及体温、尿量、血气、电解质、酸碱平衡指标等,及时发现、处理问题。结果74例均顺利完成手术,术后无死亡。结论低体重婴幼儿心内直视手术麻醉中加强监测,及时发现、处理问题,重视CPB管理,强化心肌保护措施,合理选用血管活性药物,可提高手术成功率。

Objective To sum up the anaesthesia for open heart surgery of 74 infants with congenital heart diseases（CHD）. Methods The clinical data, including age, sex, body weight, and operation type and the method of CPB were retrospectively analyzed in 82 infants with less than 10 kg undergoing CHD operations from Feb. 2007 - Jun. 2008 m hospital, resign 8 case because of pero - data. Intramuscular injection of ketamine anesthesia, accompanied by parents before operating - room, establishment monitoring in operating - room, midazolam, vecuronium, the fentanyl - induced, endotraeheal intubation to intermittent positive pressure ventilation by the nose. Intermittent to fentanyl, vecuronium, continuous infusion of propofol anesthesia. Keep on monitoring of ECG, MAP, CVP, SpO2, PETCO2, SVO2 and body temperature,urine, blood gas, electrolyte, timely detection and treatment. Results All the infants were successfully cured, and none died after opration. Conclusions Low weighted infants undergoing open heart surgery in strengthening monitory,timely detection, treatment, to CPB management, enhanced myocardial protection measures and reasonable choice of vasoactive drugs, extractable enhance the success rate of operation.