低体重婴幼儿先天性心脏病手术麻醉中血糖的管理

摘要

Objective To evaluate the effect of management of perioperative blood glucose in the low birth weight infants with congenital cardiac disease who are undergoing cardiopulmonary bypass operation. Methods From 2007 to 2010, sixty children under going operations on congenital heart disease were randomly assigned to group A and group B (N= 30 in each group). The children in group A were given sugar water to drink 2 ～ 3 h before anesthesia while those in group B were given sugar water to drink 5 ～ 6 h before anesthesia. Before induction of anesthesia, both groups of children were given intramuscular injection of ketamine 8 ～ 10 mg/kg. While in the operating room, they were monitored with ECG and pulse oxygen. Anesthesia was induced with midazolam 0.05 ～0.1 mg/kg,fentanyl 3 ～ 5 pg/kg, vecuronium 0.08 ～ 0.1 mg/kg, and then endotracheal intubation was performed. Anesthesia was maintained with fentanyl 20 ～ 30 μg/kg, propofol, combined with inhalation of isoflurane. Hemodynamic variables, such as HR, MAP and CVP,were measured 5 minutes before induction (T1) ,5 minutes after induction(T2) ,5 minutes before C PB (T3), and 5 minutes after CPB (T4). At the same time, blood glucose was measured. Results There was significant difference between the two groups at T1, T2,T3 points in hemodynamics and blood glucose ( P ＜ 0.05 ). There was no significant difference between the two groups at T4 point in hemodynamics and blood glucose (P ＞ 0.05 ). Conclusion Preoperative evaluation, intraoperative monitoring, preoperative blood volume and maintaince of blood glucose are a must for low birth weight infants with congenital heart disease undergoing cardiopulmonary bypass operation.%目的 比较两组低体重婴幼儿行先天性心脏病(先心病)手术麻醉中血糖管理的效果.方法 选择我院2007-06至2010-06择期行先天性心脏病手术的低体重患儿60例,随机分为A组和B组,每组30例.A组患儿麻醉前2～3 h给予饮1次糖水,B组患儿麻醉前5～6 h给予饮1次糖水;两组患儿入手术室麻醉诱导前均给予肌肉注射氯胺酮8～10mg/kg,入室后行心电、脉搏氧监护及吸氧,麻醉诱导用咪唑安定0.05～0.1 mg/kg,芬太尼3～5μg/kg,维库溴铵0.08～0.1mg/kg,诱导后经口行气管内插管.以芬太尼20～30μg/kg,异丙酚、复合吸入异氟醚维持麻醉.于诱导前5 min(T1)、诱导后5 min(T2)、体外循环开始前5 min(T3)、体外循环结束后5 min(T4),监测以上各时点的血流动力学指标:心率(HR)、平均动脉压(MAP)、中心静脉压(CVP),同时监测各时点血糖变化.结果 两组患儿T1、T2、T3时点血流动力学指标及血糖变化差异具有统计学意义(P＜0.05).T4时点血流动力学指标及血糖变化无明显差异(P＞0.05).结论 低体重婴幼儿先心病手术麻醉做好术前评估、术中监测,术前血容量及血糖的维持是稳定围术期血流动力学的关键.