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室缺患儿静脉麻醉诱导期血流动力学的变化
The Changes of hemodynamics during induction of intravenous anesthesia in children with ventricular septal defect
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DOI:
作者:
吴赤,宋蕴安,孙瑛,张马忠
Wu Chi, Song Yunan, Sun Ying, Zhang Mazhong
作者单位:
上海儿童医学中心
Department of Anesthesiology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
关键词:
血流动力学,麻醉诱导,小儿
hemodynamic, induction of anesthesia, children
摘要:
目的 观察麻醉诱导期小儿血流动力学的变化,探讨此类患儿是否需要是定更为合理的麻醉诱导方案。 方法 选择室间隔缺损(室缺组)和心脏解剖正常(非室缺组)的择期手术、ASA分级I~II住院患儿50例,每组25例。麻醉诱导方案包括依托咪酯0.2~0.3mg/kg、罗库溴铵0.6mg/kg静脉注射;室缺组患儿镇痛药为舒芬太尼2μg/kg,非室间隔缺损组患儿为芬太尼2μg/kg。分别测量两组患儿围麻醉诱导期心率、血压和心输出量(CO),作出两组患儿血流动力学的趋势图,并且对主要时间点的结果进行重复测量的方差分析。结果 室缺组患儿的心率、血压呈下降趋势,而非室缺组患儿则表现为相反的趋势;与麻醉诱导开始时相比,气管插管后室缺组患儿CO显著降低(P < 0.05),而非室缺组则维持相对稳定。结论 室缺患儿麻醉诱导方案可能需要进一步改进以维持更为稳定的诱导期血流动力学。
Objective This study was designed to observe hemodynamic variation during induction of intravenous anesthesia in children with ventricular septal defect and to explore whether or not the induction regimen need further improvement in these pediatric patients. Methods According to cardiac anatomy, fifty pediatric patients undergoing elective operation were randomly divided to group VSD (ventricular septal defect) and group non-VSD (normal cardiac anatomy). Anesthesia was induced with intravenous etomidate 0.2~0.3mg/kg, rocuronium 0.6mg/kg and sufentanil 2μg/kg in group VSD or fentanil 2μg/kg in group non-VSD, respectively. The continuous minute-by-minute hemodynamic variables, including heart rate (HR), mean blood pressure (MAP) and cardiac output (CO), were obtained during anesthesia induction. Results The HR, MAP showed downward trend during anesthesia induction in group VSD, while group non-VSD had a opposite trend. Compared with beginning of anesthesia induction, the CO was decreased significantly (P < 0.05) after anesthesia induction in group VSD. The CO was relative stable in group non-VSD. Conclusion Regimen of anesthesia induction in children with ventricular septal defect might require further improvement in order to maintain a more stable hemodynamic induction period.
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