快通道麻醉与常规麻醉应用于小儿先天性心脏病手术的对比研究

Comparison between Fast Track Anesthesia and General Anesthesia for Surgeries of Pediatric Congenital Heart Disease

目的通过快通道麻醉与常规麻醉比较,为先天性心脏病(先心病)患儿麻醉法的选择提供依据。方法回顾性分析2008年1月至2010年12月我院住院病例中72例快通道麻醉(手术室内拔管)和同期75例常规麻醉(手术室外拔管)先心病患儿的情况,分析比较两组患儿一般情况、麻醉方法、术后转归等方面的差异。结果快通道组患儿年龄及体质量均大于常规组患儿,常规组术前并发症多于快通道组,两组比较差异有统计学意义(P<0.05);芬太尼使用剂量在常规组术中较大,而瑞芬太尼则多应用于快通道麻醉组;术后快通道组早拔管相关并发症发生例数较少;两组患儿术后进食时间及出院时间比较差异有统计学意义(P<0.05)。结论无严重肝肾功能疾患的先心病患儿实施快通道麻醉是安全可行的,并且快通道麻醉可明显减少患儿术后并发症,缩短出院时间,提高医疗资源利用率。

Objective To provide the information of applying anesthesia for children with congenital heart disease in future operations by comparing the difference between fast track cardiac anesthesia and conventional anesthesia.Methods 72 cases performing fast track anesthesia（extubated in operating room）and 75 cases under conventional anesthesia（extubated out of operating room）were selected from January 2008 to December 2010.The differences between the two groups of anesthetic methods and postoperative outcome were analyzed.Results Age and weight of children performing fast track cardiac anesthesia were higher than conventional anesthesia group,and preoperative complications in conventional anesthesia group was much more than fast track cardiac anesthesia group（P0.05）.Larger dose of fentanyl was used in conventional anesthesia group,and remifentanil was applied in fast track cardiac anesthesia group.Patients in fast track cardiac anesthesia group returned to their ward without extubation related complications.Significant difference in food-intake time and duration of hospitalization was found between the two groups（P0.05）.Conclusion Fast track cardiac anesthesia applied in operation of children with congenital heart disease without serious liver and kidney function disorders is safe and feasible,which can obviously reduce the postoperative complications and duration of hospitalization,improving the medical resources utilization.