七氟醚或氯胺酮麻醉诱导对法洛四联症患儿血流动力学的影响

Hemodynamic effects of sevoflurane or ketamine during anesthesia induction in infants and toddlers with tetralogy of Fallot

目的采用压力记录分析法（PRAM）比较七氟醚或氯胺酮对法洛四联症患儿麻醉诱导期血流动力学的影响。方法选择拟在全麻下行法洛四联症矫治术的婴幼儿36例,年龄4~24个月,随机分为两组,每组18例。分别采用8mg/kg氯胺酮肌注（K组）和6%七氟醚吸入（S组）麻醉诱导,患儿意识消失后开放外周静脉并建立桡动脉监测,连接MostCare监测仪,采用PRAM监测血流动力学参数,依次静注咪达唑仑0.2mg/kg、哌库溴铵0.2mg/kg和舒芬太尼1μg/kg,气管插管后行机械通气。记录建立有创动脉测压后即刻（T_0）、静脉用药后1min（T_1）、2min（T_2）、5min（T_3）和气管插管后1 min（T_4）、2 min（T_5）、5 min（T_6）、10 min（T_7）的HR、SBP、DBP、心脏指数（CI）、每搏量指数（SVI）、体循环阻力指数（SVRI）和压力升支最大斜率（dp/dt）,并计算心率-收缩压乘积（RPP）。结果与T_0时比较,T_1~T_7时两组HR明显减慢,RPP明显降低（P〈0.05）;K组T_1~T_7时SBP、DBP、CI,T_1~T_4、T_6时SVI,T_2~T_7时SVRI和dp/dt明显降低（P〈0.05）;S组T_4~T_7时SBP、T_7时DBP、T_4~T_7时CI、T_3~T_7时SVI明显升高（P〈0.05）。S组T_0、T_3~T_7时HR、RPP,T_0时DBP、CI,T_0、T_1时SBP和T_0~T_6时dp/dt明显低于K组（P〈0.05）;S组T_7时DBP、CI,T_3~T_7时SVI均明显高于K组（P〈0.05）。结论与氯胺酮比较,七氟醚更有利于维持法洛四联症婴幼儿麻醉诱导期血流动力学稳定。

Objective To compare the hemodynamic effects of sevoflurane and ketamine during anesthesia induction in infants and toddlers with tetralogy of Fallot（TOF）by using pressure recording analytical method（PRAM）.Methods Thirty-six infants and children aged 4-24 months old,scheduled for repair of TOF under general anesthesia,were randomly divided into two groups.Anesthesia was induced with 6% sevoflurane inhalation（group S）or intramuscular ketamine 8 mg/kg（group K）,respectively.Peripheral intravenous catheterization and radial artery pressure monitoring were set up after the loss of consciousness,and hemodynamic parameters were monitored with most-care device PRAM.Midazolam 0.2mg/kg,pipecuronium 0.2mg/kg and sufentanil 1μg/kg were given intravenously,and the ventilation was controlled mechanically after tracheal intubation.HR,SBP,DBP,CI,SVI,SVRI and the maximal slope of systolic upstroke（dp/dt）were recorded,and HR-SBP product（RPP）was calculated,immediately after setting up of artery pressure monitoring（T_0）,1min（T_1）,2min（T_2）,5min（T_3）after intravenous administration,and 1min（T_4）,2min（T_5）,5min（T_6）,10min（T_7）after tracheal intubation.Results Compared to T_0,HR and RPP at T_1-T_7 decreased in both groups（P〈0.05）;In group K,SBP,DBP and CI at T_1-T_7,SVI at T_1-T_4,T_6,SVRI and dp/dt at T_2-T_7 significantly decreased（P〈0.05）;In group S,SBP at T_4-T_7,DBP at T_7,CI at T_4-T_7,and SVI at T_3-T_7 significantly increased（P〈0.05）.HR and RPP at T_0,T_3-T_7,DBP and CI at T_0,SBP at T_0,T_1 and dp/dt at T_0-T_6 in group S were significantly lower than those in group K（P〈0.05）;while DBP at T_7,CI at T_7 and SVI at T_3-T_7 in group S were significantly higher than those in group K（P 0.05）.Conclusion In infants and toddlers with tetralogy of Fallot,the hemodynamics was more stable when the anesthesia was induced with sevoflurane compared to ketamine.