摘要
目的探讨非体外循环下双向格林术围术期的麻醉处理。方法48例施行非体外循环下双向格林手术患者,年龄5个月至29岁,体重7～51kg,气管插管全麻,采用中小剂量芬太尼(15～20μg/kg)维持麻醉,必要时辅以低浓度的异氟醚吸入,术中通过及时补充血容量、静注血管活性药物和行上腔静脉引流等方法预见性处理循环变化。结果全组死亡1例,余均顺利完成手术。SpO2由术前(75.67±11.08)%升到(89.53±6.56)%,均于术后24h内脱离呼吸机,ICU停留时间(3.2±1.6)d,所有患者呼吸支持时间、输血浆量、术后引流量、ICU停留时间均明显少于同期CPB组(P<0.01)。结论术前正确评估患者病情,术中维护心血管功能稳定和维持低状态肺血管阻力是手术能否顺利进行的关键,同时加强血液和脑保护是术后迅速恢复的重要保证。
Objective To evaluate the Anesthesic management in bidirectional Glenn shunt without cardiopulmonary bypass （CPB）. Methods Forty eight patients underwent bidirectional Glenn shunt without CPB, with age from 5 months to 29 years and weight from 7 kg to 51 kg. Anesthesia was maintained with intravenous small or middle dose of fentanyl （15-20 μg/kg） and supplemented with low concentration of isoflurane inhalation. Resolve the circulatory problem in time by improving the blood volume, using the inotropic agents, and performing the drainage of the superior vena cava during operation. Results There was one postoperative deaths. The mean SpO2 was increased from （75.67±11.08）% to （89.53±6.56）% after operation. The postoperative extubation times were less than 24 hours. The mean time of ventilation, the volume of drainage, the amount of blood transfusion and ICU stay were significantly less than those with CPB at the corresponding period （P〈0.01）. Conclusion Precise preoperative evaluation, using small or middle dose of fentanyl, assure the data of hemodynamics satisfied and vasodilation of lung are the key factors to improve surgery outcome. The protection of blood and brain is importance for recover.
出处
《中国心血管病研究》
CAS
2005年第10期769-771,共3页
Chinese Journal of Cardiovascular Research
关键词
麻醉药
双向格林术
体外循环
Anesthetics
Bidirectional Glenn shunt
Extracorporeal circulation
