不同浓度七氟烷对小儿先天性心脏病心内直视手术血流动力学及心肌酶的影响

Effects of sevoflurane with different concentrations on hemodynamics and myocardial enzymes during open heart surgery in children with congenital heart disease

目的:对比不同浓度七氟烷对先天性心脏病(简称先心病)心内直视手术患儿血流动力学、心肌酶的影响。方法:选取择期行先心病心内直视手术患儿75例,男36例、女39例,年龄5~11岁,根据七氟烷吸入浓度分为S1组、S2组、S3组,各25例。麻醉诱导:静脉注射0.05~0.10 mg/kg咪达唑仑、0.2~0.3 mg/kg依托咪酯、1.0~2.0μg/kg舒芬太尼以及0.8 mg/kg罗库溴铵;麻醉维持:麻醉诱导后行气管插管,自机械通气起S1、S2、S3组患儿分别持续吸入体积分数2.0%、2.5%、3.0%七氟烷,同时持续静脉泵注9~12μg·kg^(-1)·min^(-1)罗库溴铵、2.0~2.5μg·kg^(-1)·h^(-1)舒芬太尼、0.2~0.7μg·kg^(-1)·h^(-1)右美托咪定直至手术结束。记录3组患儿体外循环(CPB)时间、主动脉阻断(ACC)时间、转机时间、机械通气时间;分别于术前(T0)、麻醉诱导后(T1)、切皮后(T2)、劈胸骨后(T3)、术毕(T4)、术后6 h(T5)、术后24 h(T6)、术后48 h(T7)、术后72 h(T8)监测血流动力学指标[T0、T1~T4,平均动脉压(MAP)、心率(HR)]及血浆心肌酶[T0、T5~T8,心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)]水平。结果:3组患儿CPB时间、ACC时间、转机时间、机械通气时间比较,差异均无统计学意义(P>0.05)。3组患儿MAP、HR随时间变化均呈先降低再升高趋势;血浆cTnI、CK-MB水平随时间变化均呈先升高再降低趋势,且T5~T7时S1、S2、S3组呈降低趋势(P<0.05)。结论:体积分数2.0%、2.5%、3.0%的七氟烷对先心病心内直视手术患儿血流动力学的影响没有区别。

Aim:To compare the effects of inhaled sevoflurane with different concentrations on hemodynamics and myocardial enzymes in children with congenital heart disease undergoing open heart surgery.Methods:A total of 75 children with elective congenital heart disease open heart surgery(36 males and 39 females,aged 5-11 years) were selected.According to sevoflurane inhalation concentration,75 cases were divided into S1 group,S2 group,S3 group,25 cases in each.Induction of anesthesia:intravenous injection of 0.05-0.10 mg/kg midazolam,0.2-0.3 mg/kg etomidate,1.0-2.0 μg/kg sufentanil and 0.8 mg/kg rocuronium.Anesthesia maintenance:tracheal intubation was performed after induction of anesthesia,and children in group S1,S2,and S3 were continuously inhaled with volume fractions of 2.0%,2.5%,and 3.0% sevoflurane,respectively,and at the same time injected with 9-12 μg·kg^(-1)·min^(-1)rocuronium,2.0-2.5 μg·kg^(-1)·h^(-1)sufentanil,0.2-0.7 μg·kg^(-1)·h^(-1)dexmedetomidine until the end of the operation.The cardiopulmonary bypass(CPB) time,aortic cross-clamp(ACC) time,transit time,and mechanical ventilation time were recorded in the three groups.Before operation(T0),after anesthesia induction(T1),after skin incision(T2),after sternum split(T3),after operation(T4),6 hours after operation(T5),24 hours after operation(T6),48 hours after operation(T7),and 72 hours after operation(T8),hemodynamic indexes[T0,T1 to T4,mean arterial pressure(MAP),heart rate(HR)]and plasma myocardial enzymes(T0,T5 to T8,cTnI,CK-MB) levels were monitored.Results:There were no significant difference in CPB time,ACC time,transit time,or mechanical ventilation time among the three groups(P>0.05).The MAP and HR of the three groups showed a trend of first decreasing and then increasing with time;plasma levels of cTnI and CK-MB in the three groups showed a trend of first increasing and then decreasing with time,and S1,S2,S3 group showed a trend of decreasing from T5 to T7(P<0.05).Conclusion:The effects of 2.0%,2.5% and 3.0% sevoflurane on the hemodynamics of children with congenital heart disease open heart surgery have no difference.