静脉麻醉药对先心病合并肺动脉高压病人肺循环阻力的影响

Influence of intravenous anesthetics on pulmonary vascular resistance in patients with congenital heart disease complicated by pulmonary hypertension

目的 探讨硫喷妥钠、异丙酚、氯胺酮用于先心病合并肺动脉高压病人麻醉诱导的可行性。方法 18例先心病合并肺动脉高压病人随机分成三组,分别应用硫喷妥钠2 mg/kg、氯胺酮1 mg/kg、异丙酚1 mg/kg直接注入肺动脉;测定用药前、用药后1 min、5 min的肺血管阻力。结果 用药后三组病人肺循环阻力的变化均无统计学意义;硫喷妥钠、异丙酚组体动脉压显著下降。结论 硫喷妥钠、氯胺酮、异丙酚用于先心病合并肺动脉高压病人的麻醉诱导是安全的。

Objective To determine if thiopental, propofol and ketamine can be safely used for induction of anesthesia in patients with congenital heart disease complicated by pulmonary hypertension. Methods Eighteen patients with congenital heart disease complicated by pulmonary hypertension were studied. Age ranged from 14 to 31 yr and body weight from 35 to 57 kg. The patients were premedicated with intramuscular pethidine 1 mg· kg-1 and scopolamine 0.3 mg. Swan-Ganz catheter was inserted through internal jugular vein. The patients were randomized to receive thiopental 2 mg·kg-1 , propofol 1 mg·kg-1 or ketamine 1 mg·kg-1 administered slowly via Swan-Ganz catheter for induction of anesthesia. MAP, high arterial pressure (RPA), mean pulmonary arterial pressure (MPAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO) and pulmonary vascular resistance (PVR) were measured before induction of the intravenous anesthetics. Results PVR unchanged significantly after ketamine , thiopental and propofol as compared with the baseline value. MAP was significantly decreased after injection of thiopental and propofol. Conclusion Thiopental, propofol and ketamine can be safely used for induction of anesthesia in patients with congenital heart disease complicated by pulmonary hypertension.