不同浓度七氟醚复合骶管麻醉对小儿左心功能的影响

Effect of different concentrations of sevoflurane combined sacral canal anesthesia on left ventricular function in children

目的观察不同浓度七氟醚复合骶管麻醉对小儿左心功能的影响。方法选择择期行泌尿外科手术的患儿60例,ASA分级Ⅰ级,年龄6个月~3岁,体质量5~20kg,随机分为A、B、C 3组。吸入6%七氟醚进行诱导,新鲜气流量为4L/min,待3组患儿达到满意麻醉深度后置入合适型号的喉罩,连接麻醉机,行单次骶管阻滞,确认骶管穿刺成功后将0.25%罗哌卡因按1mL/kg缓慢注入。术中3组以低流量的氧气（1L/min）以及分别以0.5最低肺泡浓度（minimum alveolar concentration,MAC）、1 MAC和1.5 MAC的七氟醚吸入维持麻醉。由超声科医师分别于麻醉诱导前（T_1）、置入喉罩前即刻（T_2）、置入喉罩后10min（T_3）、置入喉罩后30min（T_4）、拔除喉罩后20min（T_5）、拔除喉罩后1h（T_6）6个时间点测量患儿T_ei指数,并记录这6个时间点的平均动脉压（mean arterial pressure,MAP）和心率（heart rate,HR）。结果随着时间的推移,3组MAP和HR均呈现先降再升的波动起伏,且随着七氟醚吸入浓度的增加,其波动逐渐增大;3组MAP和HR组间、时间点、组间·时间点交互作用差异均有统计学意义（P〈0.01）。随着时间的推移,3组T_ei指数均呈现先升后降的波动趋势,且随着七氟醚吸入浓度的增加,其波动逐渐增大;3组T_ei指数组间、时间点、组间·时间点交互作用差异均有统计学意义（P〈0.01）。结论随着七氟醚浓度的升高,患儿心功能呈剂量依赖性降低。

Objective To evaluate the effect of different concentrations of sevoflurane combined sacral canal anesthesia on the left ventricular function in children.Methods American Society of Anesthesiologists（ASA）gradeⅠ 60 children,aged 6month to 3years old,weighting5-20 kg,were randomly divided into three groups.The children inhaled 6% sevoflurane for induction.After reaching satisfactory anesthetic depth,a laryngeal mask was put into the mouth,connected the anesthesia machine,then children were performed single sacral canal blocking,confirming the success of puncture then injected 0.25% ropivacaine slowly.During surgery,different concentrations of sevoflurane were given to maintain anesthesia.The Tei index was measured at six time points：before anesthesia induction（T_1）,immediately before placing a laryngeal mask（T_2）,ten minutes after placing a laryngeal mask（T_3）,thirty minutes after placing a laryngeal mask（T_4）,twenty minutes after remoal of laryngeal mask（T_5）,one hour after remoal of laryngeal mask（T_6）by ultrasound doctor,and MAP and HR were recorded at the six time points.Results Comparison of three groups at different time,MAP and HR first dropped then rose in ups and downs of fluctuation.With the increasing concentration of sevoflurane inhalation,the volatility increased gradually（P0.01）.Tei index of three groups first lowered,and increased with the concentration of sevoflurane inhalation,the volatility increased gradually（P0.01）.Conclusion Although sevoflurane anesthesia does not induce cardiovascular events,the left ventricular function in children showed a dose dependent decrease.