七氟醚吸入麻醉对不同年龄患儿血流动力学的影响

Hemodynamic effects of sevoflurane inhalation anesthesia on children of different ages

目的采用压力记录分析法(pressure recording analytical method,PRAM)比较不同浓度七氟醚吸入麻醉对不同年龄组患儿麻醉过程中血流动力学的影响。方法选择2017年7月至2018年2月首都医科大学附属北京儿童医院择期全麻手术患儿40例,按年龄分为10月龄至5岁的小龄组(A组)和6~14岁的大龄组(B组)。两组均给予8%七氟醚诱导,联合罗库溴铵0.6 mg/kg气管插管,插管后调节呼气末七氟醚浓度(CETSEV)分别维持在2%、3%、4%、5%,每个浓度维持至少5 min,记录CETSEV2%(T1),3%(T2),4%(T3)、5%(T4)时患儿的HR、MAP、心脏指数(cardiac index,CI)、体循环阻力指数(systemic circulation resistance index,SVRI)、每搏量指数(stroke volume index,SVI)、心脏循环效率(cardiac cycle efficiency,CCE)和压力升支最大斜率(maximal slope of systolic upstroke,dp/dt)等参数,并计算相邻时间点(△T1=T2-T1;△T2=T3-T2;△T3=T4-T3)各参数的差值变化(△HR、△MAP、△CI、△SVRI、△SVI、△CCE、△dp/dt)。结果 B组T3、T4时HR高于T1,T4时高于T2(P<0.05);A组T2、T3、T4时MAP均低于T1,T4低于T2,B组T4时MAP低于T1(P<0.05);A组T3、T4时CI均低于T1,T4低于T2(P<0.05);A组T4时SVI低于T1(P<0.05);B组T4时CCE低于T1(P<0.05);A组T3、T4时dp/dt低于T2,B组T4时dp/dt低于T1(P<0.05);两组比较,△T1时,A组MAP降低较B组明显;△T2时,B组HR升高较A组明显,A组CCE及dp/dt下降较B组明显;△T3时,A组CI及SVI降低较B组明显,B组SVRI降低较A组明显(P<0.05)。结论七氟醚麻醉时对不同年龄组患儿的血流动力学影响有差异,小龄组主要表现为心肌抑制,大龄组降低外周循环阻力作用较明显。

Objective To compare the hemodynamic effects of sevoflurane inhalation anaesthesia with different concentrations on young and older children by pressure recording analytical method(PRAM).Methods Forty patients undergoing elective surgery(ASAⅠ~Ⅱ)were classified into younger group(Group A)aged from 10 months to 5 years,and older group(Group B)aged from 6~14 years.All patients were induced by 8%sevoflurane and then combined with rocuronium 0.6mg/kg.After intubation,sevoflurane was titrated to generate an end-tidal concentration(CETSEV)of 2%(T1),3%(T2),4%(T3),and 5%(T4)respectively,and each CETSEVwas kept for at least 5 min.HR,MAP,cardiac index(CI),systemic circulation resistance index(SVRI),stroke volume index(SVI),cardiac cycle efficiency(CCE)and dp/dt were recorded at every steady stage of end-tidal sevoflurane concentrations.The difference value of each parameters(△HR,△MAP,△CI,△SVRI,△SVI,△CCE and△dp/dt)were calculated between adjacent time period(△T1=T2-T1;△T2=T3-T2;△T3=T4-T3).Results Compared to T1,HR at T3and T4increased and HR at T4was higher than that at T2in group B(P<0.05).MAP decreased after T1in group A,and MAP at T4was lower than that at T2and T1in group A and group B respectively(P<0.05).Compared to T1,CI at T3and T4decreased and CI at T4was lower than that at T2in group A(P<0.05).SVI and CCE at T4was significantly lower than that at T1in group A and group B respectively(P<0.05).dp/dt at T3and T4was lower than that at T2in group A,and dp/dt at T4was lower than T1in group B(P<0.05).Furthermore,during△T1MAP decreased more significantly in group A than in group B(P<0.05).During△T2HR increased more significantly in group B,while CCE and dp/dt decreased more significantly in group A(P<0.05).During△T3,significant decline of CI and SVI was seen in group A and SVRI in group B(P<0.05).Conclusions Sevoflurane anesthesia has distinctive effects on hemodynamics in children with different age.Children with young age are mainly manifested as inhibition of myocardial contractility,while those of older age show reduced resistance of peripheral circulation significantly.