中国体外循环杂志2012，Vol.10Issue(2)：103-105,3.
新生儿复杂先天性心脏病外科手术麻醉围术期处理
Anesthesia management strategy for neonate surgery with complex congenital heart disease
蒋怡燕 1乔彬 1吴莉莉 1林晓娜1
作者信息
- 1. 250022,济南,济南军区心血病研究所麻醉科
- 折叠
摘要
Abstract
Objective To investigate anesthesia management strategy for neonate surgery with complex congenital heart disease ( CHD ). Methods 85 cases weight of 1.9 -4.5 kg ( mean of 3.45 kg ). The diagnosis of these neonates included 2 cases of abnormal right pulmonary art cay origin with ventricular septal defect ( VSD ), 8 cases of aortic coarctation ( CoA ) with VSD and patent dust-us arteriosus ( PDA), 6 cases of interrupted aortic arch ( IAA ) with VSD and PDA, 20 cases of VSD with atrial septal defect ( ASD ) and PDA, 8 cases of double — outlet right ventricle ( DORV ), 21 cases of complete transposition of great arteries ( TGA ), 9 cases of tetralogy of Fallot ( TOF ) with pulmonary atresia and 11 cases of total anomalous pulmonary venous connection ( TAPV C ) were included. The patients were given midazolam 0. 5 mg/kg by oral and scopolamine 0. 02 — 0. 04 mg/kg by intramuscular 30 min before the operation. Dopamine 3—5μg/( kg ? min) was infused persistently if heart failure happened before the operation. The patients with great vessels complete transposition and with an intact ventricular septum were dealing without high 02 and prostaglandin El ( PGE1 ) 5 — 10 ng/( kg ? min) was given persistently until extincorporeal circulation begin. Periphery vein was opened and the EGG, SpO2 and non — invasive blood pressure were monitored after the patient entered the operation room. Fentanyl 5μg/kg and vecuronium 0. 1 mg/kg were applied for anesthesia induction and all the patients were trans nose; trachea! intubated with pressure control ventilation. Intravenous — inhalation combined anesthesia maintenance was adopted. The arterial pressure, central venous pressure, gas analysis, electrolyte a-nalysis, glucose, lactic acid and cardiac output ( CO ) were monitored continuously and corrected in time during the operation. The ilo-prost solution was inhaled to reduce pulmonary hypertension ( PH ) if the pressure declined unsatisfied after the surgery. Interim pacemaker was placed to maintain normal heart rate if heart block happened. Results The anesthesia for all of the 85 cases was satisfied. 81 cases were successfully carried on surgeries. 10 cases were dealing with delayed breastbone closed and 5 cases with peritoneum dialysis. 2 cases died because of severe low cardiac output and heart failure. 2 cases of TGA died due to abnormal coronary artery and heart dysfunction. The other cases waked up in 6 —8 h after surgeries and withdrew mechanical ventilation in 24 — 72 h. There were no complications related to anesthesia in all the cases. Conclusion The anesthesia management for neonate is different ram pared with a-dult and children. The management strategy depends on characters of neonate physiology and anatomy. Neonate anesthesia points should be mastered which is necessary to ensure the safer;' of surgery for neonate complex CHD.关键词
新生儿/复杂先天性心脏病/围术期/麻醉处理策略Key words
Neonate/ Complex congenital heart disease/ Anesthesia management strategies分类
医药卫生引用本文复制引用
蒋怡燕,乔彬,吴莉莉,林晓娜..新生儿复杂先天性心脏病外科手术麻醉围术期处理[J].中国体外循环杂志,2012,10(2):103-105,3.
