依托咪酯复合舒芬太尼和七氟烷对左向右分流先天性心脏病婴儿血流动力学的影响

Effect of etomidate with sufentanil and sevoflurane on hemodynamics in infants with congenital heart disease shunting from left to right

目的初步探索依托咪酯复合舒芬太尼和七氟烷对左向右分流的先天性心脏病婴儿血流动力学的影响。方法共纳入22例美国麻醉医师学会(ASA)分级Ⅰ至Ⅲ级,年龄≤1岁,拟在全身麻醉下行择期心脏外科手术的左向右分流先天性心脏病患儿。患儿入手术室后面罩吸入体积分数为0.05的七氟烷,经外周静脉依次注射舒芬太尼2μg/kg、罗库溴铵0.6mg/kg和依托咪酯0.3mg/kg。在麻醉诱导前和诱导后1、3、5min各时间点,记录患儿的收缩压(SBP)、舒张压(DBP)和心率(HR)。血流动力学数据采用重复测量方差分析。结果麻醉诱导前后各时间点患儿的SBP、DBP、HR的差异均无统计学意义(P值均>0.05),麻醉诱导后1min的SBP、DBP、HR分别较麻醉诱导前下降3.8%、6.4%、2.4%。结论依托咪酯复合舒芬太尼和七氟烷用于左向右分流的先天性心脏病婴儿的麻醉诱导对血流动力学的影响小,较为安全。

Objective To preliminarily explore the effect of anesthesia induction with etomidate, sufentanil and sevofJurane on hemodynamics in infants with congenital heart disease （CHD~） shunting from Jeff to right. Methods Twenty two infants with CHD and American Society of Anesthesiologists （ASA） physical status I - Ⅱ, aged no more than one year old and scheduled for cardiac surgery, were enrolled in the study. After patients entered operation room, drugs were given sequentially as follows： 5% sevoflurane via facemask, and 2 μg/kg sufentanil, 0.6 mg/kg rocuronium and 0.3 mg/kg etomidate in peripheral vein. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, and heart rate （HR） were recorded before and after induction of anesthesia at 1, 3 and 5 min. Hemodynamic data were analyzed with repeated analysis of variance. Results There was no significant difference in SBP, DBP or HR between each time point before and after induction （all P〉 0.05）. SBP, DBP and HR at 1 minute after induction as compared with the values before induction were reduced by 3. 8%, 6.4%, and 2. 4%, respectively. Conclusion Stable hemodynamics can be maintained during induction of etomidate with sufentanil and sevoflurane in infants with CHD shunting from left to right. （Shanghai Med J, 2013, 36： 687-689）