七氟醚全凭吸入在小儿先心病介入封堵术中的应用

Application of Sevoflurane Inhalation in Transcatheter Closure for Children with Congenital Heart Disease

目的：比较七氟醚全凭吸入与氯胺酮复合丙泊酚静脉麻醉在小儿先心病介入封堵术中的应用,探讨七氟醚全凭吸入麻醉在小儿先心病介入封堵术中的可行性和安全性。方法：选择拟行小儿先心病介入封堵术患儿60例,年龄2-5岁,体重8-14kg,ASAⅠ或Ⅱ级,随机均分为两组：七氟醚全凭吸入麻醉组（七氟醚组）和氯胺酮复合丙泊酚静脉麻醉组（氯胺酮组）。七氟醚组以吸入8%的七氟醚进行麻醉诱导,氧流量6 L/min,术中以2%-3%的七氟醚维持麻醉,氧流量2 L/min。氯胺酮组以氯胺酮1.5-2.0 mg/kg静脉诱导,术中以氯胺酮25-30μg/（kg·min）,丙泊酚1.5-2.0 mg/（kg·h）微量泵持续输注维持麻醉。监测并记录患儿入室时（T1）、麻醉诱导后（T2）、穿刺即刻（T3）、置封堵器即刻（T4）和手术结束时（T5）的SBP、DBP、HR和Sp O2。记录麻醉诱导时间和苏醒时间。观察并记录术后苏醒期躁动、恶心呕吐、呼吸抑制等并发症。结果：两组患儿一般资料及手术麻醉时间差异无统计学意义,所有患儿镇静、镇痛效果满意,无一例改为气管插管。七氟醚组患儿的诱导时间与氯胺酮组比较差异无统计学意义,但七氟醚组术后苏醒时间、定向力恢复时间均短于氯胺酮组（P〈0.05）。术中无意识肢动发生率七氟醚组3例（10%）与氯胺酮组5例（17%）差异无统计学意义。两组均未出现呛咳、呼吸抑制、喉痉挛及支气管痉挛等不良反应。苏醒期躁动发生率七氟醚组3例（10%）明显低于氯胺酮组5例（17%）,P〈0.05。结论：七氟醚全凭吸入麻醉能达到满意的镇静、镇痛效果,且对循环呼吸影响小,可安全有效地应用于小儿先心病介入封堵术。

Objective： To compare the application of sevoflurane inhalation and ketamine combined with propofol intravenous anesthesia in the transcatheter closure for children with congenital heart diseasen, and to discuss the feasibility and safety of using sevoflurane inhalation. Methods： Sixty children, aged 2 to 5 years old, body weight 8- 14 kg, ASA Ⅰ or Ⅱ, with pediatric interventional therapy were randomly divided into two groups： sevoflurane inhalation anesthesia group（sevoflurane group） and ketamine combined with propofol intravenous anesthesia group（ketamine group）. Sevoflurane group were anesthesia induction with8% sevoflurane（oxygen flow rate at 6 L/min）and anesthesia maintenance with 2%- 3% sevoflurane（oxygen flow rate 2 L/min）.Ketamine group were anesthesia induction with 1.5-2.0 mg/kg ketamine intravenously and anesthesia maintenance with 25-30 μg/（kg·min）ketamine, 1.5- 2.0 mg/（kg · h）propofol trace pump injection continuously. SBP, DBP, HR, Sp O2, anesthesia induction time,recovery time,and postoperative complications were recorded and investigated. Results： There were no differences between general information and operation time in two groups. The sedation and analgesia effect were satisfactory in all patients, and no case was changed to tracheal intubation. The induction time in two groups were not significantly different. But the postoperative recovery time,orientation recovery time in sevoflurane group were shorter than that in ketamine group（P〈0.05）. There was no statistic significant difference on consciousness limb activity between sevoflurane group（3 cases, 10%）and ketamine group（5 cases,17%）. The two groups were free of cough, adverse respiratory inhibition, laryngospasm and bronchospasm. The incidence of agitation during emergence in sevoflurane group（10% 3 cases）was significantly lower than that in the ketamine group（17%, 5 cases）（P〈0.05）.Conclusion： Sevoflurane inhalation anesthesia, with little influence on circulation and respiration, could achieve satisfactory analgesia and sedation, is safe and effective in interventional therapy of children with congenital heart disease.