地氟醚与安氟醚对小儿血液动力学影响的比较

Comparison of the hemodynamic effects of desflurane and enflurane in children

目的 采用经食道多普勒连续心输出量监测仪 (TECO1)测量地氟醚对小儿血液动力学的影响并与安氟醚进行比较 ,为临床合理选用麻醉药提供参考。方法 2 8例择期行会阴及骨科矫形手术 1～ 5岁小儿 ,ASAⅠ～Ⅱ级 ,快速诱导插管后随机分为吸入地氟醚 (D组 )和安氟醚 (E组 )两组。用TECO1分别测量呼出气体麻醉药浓度为 0、0 5、1 0和 1 5MAC稳定 5min后的SVI、CI及HR ,同时监测SP、DP及MAP。结果 与吸入麻醉药前相比 ,两者在 0 5MAC均引起相似幅度的轻度血压下降 ,CI、SVI及HR无明显改变。 1 0MAC时D组CI明显升高 ,并高于E组 ;D组HR及SVI增高与基础值比无统计学差别 ,但明显高于E组 ;两组血压均进一步下降 ,但幅度无差别。 1 5MAC时 ,E组的CI及SVI明显降低 ,而D组则无明显变化 ;D组HR增快 ,与E组有明显差别 ;两组血压进一步降低 ,E组MAP和SP下降幅度明显大于D组 ,DP无差别。

Objective The purpose of this study was to determine and compare the hemodynamic effects of desflurane and enflurane in children.Methods Twenty-eight ASA Ⅰ-Ⅱ patients, aged 1-5 years were randomly assigned to receive either desflurane (group D) or enflurane (group E) for maintenance of anesthesia.Cardiac output was continuously monitored by transesophageal Doppler (TECO1).The stroke volume index (SVI), cardiac index (CI),heart rate (HR) and blood pressure(SBP,DBP,MAP) were determined before and during inhalation of desflurane and enflurane at 0.5,1.0 and 1.5 MAC.Results At 0.5 MAC of both agents SVI, CI and HR remained unchanged, but SBP, DBP and MAP were slightly reduced as compared to the baseline values.At 1.0 MAC of desflurane CI was increased and was higher than that in the group E. SVI and HR were significantly higher in group D than those in group E at 1.0 MAC.SBP, MAP and DBP were further reduced and the magnitude of reduction was similar between both groups.At 1.5 MAC CI and SVI were unchanged in group D but greatly reduced in group E.HR increased significantly in group D but remained unchanged in group E.There was further decrease in BP in both groups but SBP and MAP decreased more markedly in group E than in group D .Conclusions Desflurane causes less hemodynamic changes in children of 1-5 years than enflurane.