摘要
目的 研究麻醉和心内直视手术对小儿自主神经的影响。方法 2 0例ASAⅠ～Ⅱ先天性心脏病手术的患儿。麻醉诱导 :羟丁酸钠 80～ 10 0mg/kg ,芬太尼 3μg/kg ,潘龙 0 0 8～ 0 1mg/kg ,气管插管。麻醉维持 :芬太尼切皮前总量达到 30 μg /kg ,于转机前和停机后静脉注射 10 μg /kg。潘龙 0 1mg/kg分别于切皮、转机前、停机后静脉注射。羟丁酸钠于转机前停机后静脉注射 4 0mg/kg。体外循环 :西京鼓泡式氧合器 ,改良托马液 15～2 0ml/kg主动脉灌注。主动脉阻断时间 ( 4 6± 2 4 )min ,转机时间 ( 81± 31)min。监测术前、切皮前、体外前、停机后、关胸后、术后 1d、术后 2d的低频、高频、总频、低频 /高频以及术中各时点脑电双频指数 (BIS)值。结果 与切皮时比较 ,体外循环后心率变异性各值明显减低 ,P <0 0 5。与手术前比较 ,手术后当日、术后 1、2d心率变异性各值减低并逐渐恢复 ,P <0 0 5。结论 麻醉、体外循环、手术操作以及低温对患儿的自主神经系统有较大的抑制作用 ,并持续到 2d以上。
Objective To investigate the effect of anesthesia,cardiopulmonary bypass (CPB) and open heart surgery on autonomic nervous system in children.Methods Twenty ASA Ⅰ～Ⅱ patients who underwent open heart surgery were studied.Induction of anesthesia with sodium hydroxybutyrate 80～100 mg/kg,fentanyl 3 mg/kg and pavulon 0 08～0 1 mg/kg.Maintenance dose of fentanyl totaled 30 μg /kg before cutting skin,10 μg/kg before and after CPB.Pavulon 0 1 mg/kg was injected in vein before cutting skin,before and after CPB.Sodium hydroxybutyrate 40 mg/kg was injected in vein before and after CPB.Cardiopulmornary bypass:hollow fiber oxygenator,cold modified Thoma′s fluid 20 ml/kg,AO block time (46±24) min,CPB time was (81±31) min.LF,HF,TP and LF/HF were monitored before operation,cutting skin,before CPB,after CPB,closing the chest,1 d and 2 d after operation.Results In comparison with that duing the skin cutting,HRV decreased after CPB ( P<0 05 ).HRV decreased after operation,1 d and 2 d after operation ( P <0 05).Conclusion Anesthesia,CPB,open heart surgery and low temperature can restrain children′s automonic nervous system,lasting 2 days and over.
出处
《中国药物与临床》
CAS
2003年第6期474-476,共3页
Chinese Remedies & Clinics
基金
山西省卫生厅科研基金资助项目 (2 0 0 2 2 5 )
关键词
小儿
心率变异性
心内直视手术
麻醉
自主神经
Heart defects
Congenital
Anesthesia
Heart rate variability
Bispectral index
