七氟烷应用于非紫绀型先天性心脏病患儿麻醉诱导效果的观察

摘要

目的：观察七氟烷应用于非紫绀型先天性心脏病患儿吸入麻醉诱导的效果。方法选择非紫绀型先天性心脏病手术患儿60例,随机分为七氟烷试验组(S组,n=30),氯胺酮对照组(K组,n=30)。记录首次数据后,S组用面罩密闭于患儿口鼻处,将麻醉剂氧流量开至4L/min,七氟烷挥发罐刻度开至8%,先让患儿自主呼吸,当呼吸减弱后立即手控通气,当心率开始下降,患儿体动静止后降低氧流量和七氟烷吸入浓度,开放外周静脉注入肌肉松弛剂,当肌肉松弛后经鼻或口插入气管内导管,结束麻醉诱导。 K组处理先同S组,准备就绪后肌注氯胺酮6mg/kg,当患儿入睡后开放外周静脉注入肌肉松弛剂,手控呼吸,当肌肉松弛后经口或鼻插入气管内导管,结束麻醉诱导。两组患儿均在入睡时开始记录各种血流动力学参数和入睡时间及对刺激的各种反应。结果 S组与K组相比较,两组患儿入室时的平均动脉压( mean artery pressure, MAP)、HR、SPO2与麻醉诱导结束时差异具有显著性(P<0.05)；而两组之间的MAP、SPO2比较,差异无显著性(P>0.05)；麻醉诱导结束时两组之间的HR比较,差异有显著性(P<0.05)；患儿入睡时间S组为(57.4±18.5)秒,K组为(88.7±31.7)秒,其差异有显著性(P<0.05)。试验中K组患儿对刺激反应明显较S组强烈,且维持时间长；K组患儿经口或经鼻行气管内插管时口腔分泌物明显多于S组。结论七氟烷可应用于非紫绀型先天性心脏病患儿的麻醉诱导。%Objective Evaluate inhaled anesthesia induction effect of sevoflurane works in acyanotic congenital heart disease children. Method 60 selective operation children with acyanotic congenital heart disease,33 males and 27 females,1-6 years old,weight 10-25kg, ASA statusⅠand Ⅱ,randomly divided into sevoflurane experiment group (group S,n=30),ketamine comparison group(group K,n=30). Turn the anesthetic oxygen flow to 4L/min and the graduate of sevoflurane vaporizers to 8%. First the children are breathing spontaneously. When breathing is weaken, manual control ventilation promptly . When the heart rate begin to decline and body movement standstill,reduce the oxygen flow and sevoflurane inhaled concentration. Open peripheral venous,inject muscle relaxant . Insert endotra-cheal tube through mouth or nose after muscle relaxed. End of the anesthesia induction. Group K is dealing with the same of group S. When everything is ready,inject 6mg/kg ketamine intramuscularly. Open peripheral venous, in-ject muscle relaxant and control breathing by hand after children sleep. When muscle relaxed,insert endotracheal tube through mouth or nose. End of the anesthesia induction. Start recording the time of sleep,every kind of hemo-dynamic parameters and responses to stimuli at the beginning of two groups children fall asleep. Result Compare group S with group K,differences of MAP,HR,SPO2 when children enter the operating room and the end of anesthe-sia induction have statistics significance(P<0. 05); compare MAP,SPO2 between two groups,differences have no statistics significance(P>0. 05);differences of the comparison of HR when the anesthesia induction ends have sta-tistics significance(P<0.05);sleep time of group S is (57. 4±18. 5)s,group K is (88. 7±31. 7)s, differences have statistics significance(P<0. 05). In the experiment,obviously children of group K resist much stronger than group S and it malntalns longer time;the mouth or nasal endotracheal intubation of group K has more secretions than group S apparently. Conclusion Sevoflurance can be applied in anesthesia induction of acyanotic congenital heart disease children.