法洛四联症患儿术前镇静的研究进展

Progress of premedication in children with tetralogy of Fallot

背景法洛四联症（tetralogy of fallot，TOF）是一组心脏缺损性疾病，包括圆锥-心室室间隔缺损（ventricular septal defect，VSD）、主动脉骑跨、右心室肥厚和轻重不等的右心室流出道梗阻（right ventricular outflow tract。RVOT），合并不同程度的心脏畸形，病情随梗阻程度不同而异，多数患儿在1岁内行TOF根治术。对此类患儿，术前评估与恰当的术前镇静方案对减轻RVOT，减少右向左分流，避免术前缺氧发作是相当重要的，对麻醉诱导前病情的稳定以及麻醉诱导的安全过渡也是十分重要的。目的旨在了解TOF术前评估方法、术前镇静方案，为临床用药提供参考。内容阐述TOF患儿的病理生理、术前评估、现有术前镇静方案及不同镇静方案对TOF血流动力学的影响。趋向未来的研究方向应致力于更加安全、有效的术前镇静方案以及不同术前镇静药物对诱导用药的相互作用。

Background Tetralogy of Fallot （TOF） is a syndrome of heart defect disease including ventricular septal defect （VSD） and right ventricular outflow tract obstruction （RVOT）, with different degrees of heart malformation. The severity of the disease varies in relation to the degree of obstruction. The majority of children had their radical operation when they were within 1 year old. For these children, it is quite important to give proper preoperative evaluation and appropriate regimens for premedication in order to relieve the right ventricular outflow tract obstruction and reduce right to left shunt as well as avoid hypoxic spell, assure stable condition before induction and then facilitate smooth induction. Objective To understand the importance of preoperative assessment of TOF and regimens of preoperative sedation for TOF, and provide reference guide for clinical medication. Content The review article focused on preoperative assessment and premedication for children undergoing elective surgery. Trend Directions for future research should be committed to seeking a more safe and effective preoperative sedation regimens and interaction of different premedication and induced drug.