先天性膈疝患儿的麻醉管理53例

Anesthesia management of congenital diaphragmatic hernia in fifty-three infants

目的比较先天性膈疝(CDH)患儿七氟醚诱导维持与氯胺酮诱导复合异氟醚维持对呼吸循环及术后恢复的影响。方法 53例CDH患儿分为七氟醚诱导维持(S组,37例)与氯胺酮诱导复合异氟醚维持(K组,16例)。比较两组诱导前后HR、SBP、SpO2及麻醉苏醒时间;分析术前吸入不同的氧浓度与术后长时间(≥24 h)机械通气的相关性。结果与诱导前比较,两组诱导后SpO2均升高(P<0.05);S组诱导后HR减慢(P<0.01),但K组HR稳定;术后入ICU后的患儿中,S组诱导后及手术结束时HR减慢(P<0.01)。S组苏醒时间短于K组(P<0.01)。术前氧浓度需求≥33%的CDH患儿术后长时间机械通气的构成比高(P<0.01)。结论两种麻醉方案均能维持CDH患儿呼吸循环稳定,七氟醚能缩短患儿的苏醒时间;术前维持SpO2≥90%吸入的氧浓度可能是预测术后机械通气时间的指标。

Objective To compare the effect of sevoflurane anesthesia and ketamine combined isoflurane anesthesia on respiratory and circulatory stability and anesthesia recovery in infants with congenital diaphragmatic hernia （CDH）. Methods Fifty three infants with CDH were recruited, Thirty seven infants were anesthetized with sevoflurane （group S） and sixteen infants were induced with ketamine and maintained with isoflurane （group K）. Compared the differences of HR, SBP, SpO2 and the recovery time from anesthesia between the two groups; and then the correlation between long-last （≥ 24 h） mechanical ventilation and preoperative oxygen requirement was analyzed. Results SpO2 was significantly increased after induction in both groups （P〈0.05）. Group S displayed an obvious decrease in HR after induction （P〈0.01） and this continued till the patients transferred into ICU （P〈0.01）. The recovery time from anesthesia in group S was markedly shortened （P〈0.01）. In those （≥33%） with long-last mechanical ventilation support CDH infants, majority of them required high oxygen concentration preoperatively （P〈0.01）. Conclusion Both anesthesia strategies all can maintain respiratory and circulatory stability in infants with CDH. However, sevoflurane anesthesia has a shorter time recovered from anesthesia. Preoperative oxygen concentrations required to maintain normal SpO2 may be a predictor of the incidence of postoperative long-last mechanical ventilation in these patients.