非发绀型先天性心脏病患儿行CT检查的麻醉处理

Reasonable anesthetic managements for children with non-cyanotic congenital heart diseases receiving computed tomography

目的：总结非发绀型先天性心脏病（先心病）患儿施行CT检查术的麻醉经验方法：回顾性总结北京安贞医院,近2年期间施行的491例非发绀型先心病患儿施行CT检查术的麻醉经验。在本组病例资料中年龄均为3个月~6岁,平均（3.6±0.6）岁的先心病患儿,ASAⅡ-Ⅲ级,体质量为5.0~18.0kg平均（12.5±4.5）kg。患儿检查前6h禁食,4h禁饮。患儿送入CT室后平卧于检查床,连接心电图导联和经皮血氧饱和度探头,经预先开放的静脉通路推注丙泊酚1.5~2.0mg/kg,待患儿入睡,睫毛反射消失后开始行CT检查,并用鼻导管给予氧气吸入。结果：全组患儿均完成CT检查,大多数患儿经静脉注入丙泊酚1次（1.5~2.0mg/kg）即可完成检查,少部分需追加用量（约为首次用量的1/3）。检查中17例患儿出现经皮血氧饱和度降低（SPO2〈90%）,23例出现心动过缓（P〈100/min）,6例出现室性期前收缩等,均经及时处理后好转。结论：非发绀型先心病患儿施行CT检查,经静脉注射丙泊酚即可满足其麻醉需求,检查中对呼吸和循环的监测十分重要,一经发现异常改变应及时对症处理,即可保障患儿安全。

Objective： To summarize the experience in anesthetic managements for children with noncyanotic congenital heart diseases when receiving computed tomography. Methods： A total of 491 cases children with non-cyanotic congenital heart diseases who underwent computed tomography in Anzhen hospital during the time from March 2014 to March 2015 were retrospectively summarized for their anesthetic managements. In this population,the children aged from 3m to 6y average（ 3. 6 ± 0. 6） y,with ASA class II-III,and body weight from 5. 0 to 18. 0kg average（ 12. 5 ± 4. 5） kg. All the children fasted 6h for foods and 4h for water before surgery. The children lay in the supine position,nasal catheter oxygen inhalation were given,EKG and oxygen saturation were monitored. The patients were induced with propofol intravenously by the dosage of 1. 5 ~ 2. 0mg /kg. CT scan was begun until patients＇ eyelash reflex lost. Results： All the patients completed CT scan successfully. Bolus of propofol（ 1. 5 ~ 2. 0mg / kg） could apply for most of the patients,only some of them needed an exceptional dosage（ 0. 5 ~ 1. 0mg / kg）. There were found 17 cases with O2 desaturation below 90%,23 cases with bradycardia（ P 〈100 / min） and 6 cases with ventricular premature during perioperative period,but all the cases recovered quickly after proper managements. Conclusion： Propofol sedation could meet the anesthesia requirements for this kind of intervention. The key points for the anesthetic managements include crucial monitor of respiration and circulation. Patients＇ safety could be ensured by timely detection and treatment when abnormal situation occurred.