小儿左冠状动脉异常的矫治术麻醉管理方法探讨

Anesthetic management of anomalous left coronary artery from pulmonary artery in children

目的分析小儿起源于肺动脉的左冠状动脉异常矫治手术的麻醉特点,为今后开展类似手术提供可行的麻醉管理方法。方法回顾性分析2006年3月至2010年7月本院20例小儿起源于肺动脉的左冠状动脉异常矫治术的麻醉管理方法。结果采用静吸复合全麻,术中均未出现急性心衰或心梗,CPB时间为58～204(80.6±44.4)min,主动脉阻断时间为25～125(53.4±32.2)min,开放主动脉后均自动复跳,适时应用血管活性药物,以保证麻醉平稳,停CPB时SBP为(78.6±8.0)mmHg,DBP为(45.4±3.5)mmHg,HR为(130.8±10.5)次/min,术中无死亡及麻醉并发症。1例术后第2天死于严重低心排综合征,死亡率为5%,其余痊愈出院。结论小儿左冠状动脉异常矫治术以静吸复合全麻的方法 ,辅以严密监测,尽力维持血流动力学稳定,积极采取各种措施避免加重心肌缺血的麻醉管理方法是正确可行的,可以推广应用于术前有心功能损害的手术。

Objective To analyze the characteristics of anomalous left coronary artery from pulmonary artery in order to explore effective anesthetic management in children. Method We reviewed the anesthetic management of anomalous left coronary artery from pulmonary artery in 20 cases of children from March,.2006 to July,.2010..Results All cases accomplished surgery with general anesthesia,without happening acute myocardial infarction..Cardiopulmonary bypass（CPB） time was 58-204（80.6±44.4）min, and aortic clipped time was 25-125（53.4±32.2）min. All hearts automatically re-beat after opening aorta. We used the vasomotor drugs to keep anesthetization remain stable.After cardiopulmonary bypass,SBP was.（78.6±8.0）mmHg,DBP was.（45.4±3.5）mmHg,and HR was.（130.8±10.5）beat/min..No death or anesthetic complications happened during the operation. One child died from serious low cardiac output syndrome the next day after operation,with death rate of 5%,.and the others were cured. Conclusions The key to the anesthetic management of anomalous left coronary artery from pulmonary artery in children is to maintain the hemodynamic stability and avoid aggravating myocardial ischemia.This is the right way and we can use it in the kind of operation in children whose function of heart has been impaired.