复杂先天性心脏病手术麻醉处理体会

Anesthetic Management of Complex Congenital Heart Disease

目的探讨总结复杂先天性心脏病手术麻醉处理经验。方法选择不同类型的先心患儿11例,以舒芬太尼为主的静吸复合全麻下进行先心矫正术,均在全麻、低温、体外循环(CPB)下完成。麻醉选择对循环系统干扰小的药物,心脏复跳后给予多巴胺或肾上腺素+硝普钠等血管活性药维持循环系统功能稳定。结果10例患儿麻醉平稳,没有1例出现麻醉意外及麻醉并发症,均顺利脱离体外循环机,术后心功能恢复良好。结论选择对循环影响小的麻醉方法,术前做好充分的准备,术中加强呼吸及液体管理,围手术期循环功能监测,选择适当的血管活性药尽量维持循环系统功能稳定,是复杂先天性心脏病手术麻醉成功的关键。

Objective To explore and summarize the anesthetic experience of complex congenital heart disease. Methods 11 cases of children with different types of congenital heart diseases were treated with congenital heart surgery under sufentanil-based inhalation anesthesia, including general anesthesia, hypothermia and cardiopulmonary bypass （CPB）. At anesthesia, less interfering drugs for circulatory system were chosen; after cardiac resuscitation, dopamine or epinephrine ＋ sodium nitroprusside and other vasoactive drugs were given to maintain the circulatory stability. Results 10 cases of children with anesthesia were stable, with no case of anesthetic accident and anesthetic complications. All children were successfully f^om cardiopulmonary bypass machine, and their cardiac function recovered well after surgery. Conclusion The key to successful anesthesia for complex congenital heart disease lies in anesthesia with less interferin for circulatory system, full preoperative preparation, intraoperative respiratory and fluid management, perioperative monitoring of circulatory function, and ap- propriate vasoactive drugs as far as possible to maintain circulatory stability.