室间隔缺损患儿麻醉诱导期无通气时限的观察

The Observation of the Safety Period of Apnea during Induction of Anesthesia in Children with Ventricular Septal Defect

目的 探讨先天性心脏病室间隔缺损（ Ｖ Ｓ Ｄ）患儿能够耐受的无通气安全时限。 方法 根据 Ｖ Ｓ Ｄ大小和术中是否补片修补将２０ 例 Ｖ Ｓ Ｄ患儿分为两组。Ⅰ组：１０ 例， Ｖ Ｓ Ｄ小于１ｃｍ ，术中直接缝合修补；Ⅱ组：１０ 例， Ｖ Ｓ Ｄ大于１ｃｍ ，术中需补片修补；对照组：８ 例，选择无心、肺疾病的手术患儿作为对照。麻醉诱导后，患儿先预吸氧３ 分钟，然后开始无通气期２ 分钟，观察无通气期血气、心率、动脉血压的变化。 结果 在无通气期，３ 组患儿的动脉血氧分压均进行性降低，到无通气２ 分钟时，Ⅱ组患儿的动脉血氧分压明显低于其它两组。动脉血二氧化碳分压随无通气时间延长逐渐升高，到无通气１ 分钟时，３ 组患儿的动脉血二氧化碳分压均高于正常值的高限，组间比较无差异。在无通气期，３ 组患儿的心率、血压无明显变化，也未观察到心律失常的发生。 结论 Ｖ Ｓ Ｄ患儿心肺功能受损程度直接同 Ｖ Ｓ Ｄ大小有关，在麻醉诱导时，应将无通气时间控制在１ 分钟之内。

Objective To study the safety period of apnea that can be tolerated by children with ventricular septal defect(VSD) during induction of anesthesia. Methods Twenty children with VSD were divided into two groups,group Ⅰ(n=10):VSD was less than 1cm, repaired by simple suturing the defect; group Ⅱ(n=10):VSD was more than 1cm,repaired with prosthetic patch;control group (n=8):Children did not suffer from any diseases related to heart and lung. Anesthesia was induced with diazepam, fentanyl and vecuronium, after 3 min preoxygenation, children suffered apnea for 2 min, the changes of blood gases, heart rate and blood pressure during apnea were observed. Results During apnea, partial pressure of oxygen in artery was decreased progressively in all children,Partial pressure of oxygen in artery of children in group Ⅱ was significantly lower than that of children in other two groups at the end of apnea. Partial pressure of carbon dioxide in artery was higher than the upper limit of normal value by 1 min after apnea. There were no differences among groups. During apnea, there were no significant changes for heart rate and blood pressure in all children. Conclusion In children with VSD, cardiopulmonary functions are directly related to size of VSD. During induction of anesthesia, the period of apnea should not be longer than 1 min.