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| 七氟醚或氯胺酮麻醉诱导对法洛四联症患儿血流动力学的影响 |
| Hemodynamic effects of sevoflurane or ketamine during anesthesia induction in infants and toddlers with tetralogy of Fallot |
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| DOI： |
| 中文关键词: 法洛四联症 血流动力学 七氟醚 氯胺酮 婴幼儿 |
| 英文关键词: Tetralogy of Fallot Hemodynamics Sevoflurane Ketamine Infant |
| 基金项目: |
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| 中文摘要: |
| 目的：采用压力记录分析法(PRAM)比较七氟醚或氯胺酮对法洛四联症患儿麻醉诱导期血流动力学的影响。方法选择拟在全麻下行法洛四联症矫治术的婴幼儿36例,年龄4~24个月,随机分为两组,每组18例。分别采用8 mg/kg 氯胺酮肌注(K 组)和6%七氟醚吸入(S 组)麻醉诱导,患儿意识消失后开放外周静脉并建立桡动脉监测,连接 MostCare 监测仪,采用 PRAM 监测血流动力学参数,依次静注咪达唑仑0.2 mg/kg、哌库溴铵0.2 mg/kg 和舒芬太尼1μg/kg,气管插管后行机械通气。记录建立有创动脉测压后即刻(T0)、静脉用药后1 min (T1)、2 min (T2)、5 min (T3)和气管插管后1 min (T4)、2 min (T5)、5 min (T6)、10 min(T7)的 HR、SBP、DBP、心脏指数(CI)、每搏量指数(SVI)、体循环阻力指数(SVRI)和压力升支最大斜率(dp/dt),并计算心率-收缩压乘积(RPP)。结果与 T0时比较,T1~T7时两组 HR 明显减慢,RPP 明显降低(P <0.05)；K 组 T1~T7时 SBP、DBP、CI,T1~T4、T6时 SVI,T2~T7时 SVRI 和 dp/dt 明显降低(P <0.05)；S 组 T4~T7时 SBP、T7时 DBP、T4~T7时 CI、T3~T7时 SVI 明显升高(P <0.05)。S 组 T0、T3~T7时 HR、RPP,T0时 DBP、CI,T0、T1时 SBP 和 T0~T6时 dp/dt 明显低于 K 组(P <0.05)；S 组 T7时 DBP、CI,T3~T7时 SVI 均明显高于 K 组(P <0.05)。结论与氯胺酮比较,七氟醚更有利于维持法洛四联症婴幼儿麻醉诱导期血流动力学稳定。 |
| 英文摘要: |
| Objective To compare the hemodynamic effects of sevoflurane and ketamine during anesthesia induction in infants and toddlers with tetralogy of Fallot (TOF)by using pressure recording analytical method (PRAM).Methods Thirty-six infants and children aged 4-24 months old,scheduled for repair of TOF under general anesthesia,were randomly divided into two groups. Anesthesia was induced with 6% sevoflurane inhalation (group S)or intramuscular ketamine 8 mg/kg (group K),respectively.Peripheral intravenous catheterization and radial artery pressure monitoring were set up after the loss of consciousness,and hemodynamic parameters were monitored with most-care device PRAM.Midazolam 0.2 mg/kg,pipecuronium 0.2 mg/kg and sufentanil 1 μg/kg were given intravenously,and the ventilation was controlled mechanically after tracheal intubation.HR, SBP,DBP,CI,SVI,SVRI and the maximal slope of systolic upstroke (dp/dt)were recorded,and HR-SBP product (RPP)was calculated,immediately after setting up of artery pressure monitoring (T0 ),1 min (T1 ),2 min (T2 ),5 min (T3 )after intravenous administration,and 1 min (T4 ),2 min (T5 ),5 min (T6 ),10 min (T7 )after tracheal intubation.Results Compared to T0 ,HR and RPP at T1-T7 decreased in both groups (P <0.05);In group K,SBP,DBP and CI at T1-T7 ,SVI at T1-T4,T6 , SVRI and dp/dt at T2-T7 significantly decreased (P <0.05);In group S,SBP at T4-T7 ,DBP at T7 ,CI at T4-T7 ,and SVI at T3-T7 significantly increased (P <0.05).HR and RPP at T0,T3-T7 ,DBP and CI at T0 , SBP at T0,T1 and dp/dt at T0-T6 in group S were significantly lower than those in group K (P <0.05);while DBP at T7 ,CI at T7 and SVI at T3-T7 in group S were significantly higher than those in group K (P<0.05).Conclusion In infants and toddlers with tetralogy of Fallot,the hemodynamics was more stable when the anesthesia was induced with sevoflurane compared to ketamine. |
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