婴幼儿难治性癫痫手术治疗的麻醉处理

Anesthetic management for surgical treatment of refractory epilepsy in infants

目的探讨婴幼儿难治性癫痫手术的麻醉处理。方法对54例婴幼儿难治性癫痫手术的麻醉处理进行回顾性分析,采用七氟醚、异丙酚、瑞芬太尼复合全身麻醉,持续监测心电图(ECG)、氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)、平均动脉压(MAP)、中心静脉压(CVP)、体温及动脉血气分析,记录失血量、输血量和体温。结果术前有97.7%的患儿存在智力下降;手术时间平均为455min;术中平均失血量为842mL,约有33%患儿的失血量超过了总血容量。术中平均输血763mL,包括输浓缩红细胞、冰冻血浆和血小板。术中所有的患儿均出现了不同程度的体温下降,最低为32℃;无1例患儿发生围手术期死亡。结论婴幼儿难治性癫痫手术时间长,出血量大,容易出现术中低温。加强麻醉管理将有助于降低围术期患儿的术后并发症和死亡率。

Objective To explore the anesthetic management for surgical treatment of refractory epilepsy in infants. Methods The anesthetic management of 54 infants with refractory epilepsy were analysed retrospectively. The anesthesia was induced with fentanyl,propofol and sevoflurane. ECG, SpO2, PET CO2, MAP, CVP and body temperature were monitored continuously, arterial blood gas analysis was intermittently monitored. Blood loss, blood transfusion volume and body temperature were recorded. Results The percentage of mentally retarded infants was 97.7% before operation. The average operating time was 455min. The average estimated blood loss was 842mL during operation, which was more than the total blood volume in 33% infants. The mean volume of blood transfusion was 763mL, which including packed red blood cells, frozen plasma and platelet. The drop of body temperature was observed in all patients,the lowest one was 32℃ ;No patient died during perioperative period. Conclusion Surgical treatment of refractory epilepsy in infants has longer operative time,more bleeding amount and easy to hypothermia. Enhancing anesthetic management would be helpful to minimize the perioperative morbidity and mortality of infants.