超快通道麻醉用于低体重患儿先天性心脏病手术的效果

Effects of ultrafast track anesthesia for congenital heart disease in children with low birth weight

中文关键词: 超快通道麻醉  先天性心脏病  低体重患儿  拔管时间

英文关键词: Ultrafast track anesthesia  Congenital heart disease  Low birth weight  Extubation time

中文摘要:

      
目的 对比超快通道麻醉
方法 与传统麻醉
方法 应用于低体重先天性心脏病(congenital heart disease,CHD)患儿术中的临床效果,探讨超快通道麻醉
方法 的优势。
方法 选取CHD低体重患儿114例,男54例,女60例,年龄6个月至2岁,体重5～10 kg,ASA Ⅲ或Ⅳ级,随机分为两组: 超快通道麻醉组和传统麻醉组,每组57例。超快通道麻醉组患儿于心肺转流(cardiopulmonary bypass,CPB)开始后停七氟醚，复温开始时停止泵注顺式阿曲库铵,随后开始静脉泵注瑞芬太尼0.3 μg·kg^-1·min^-1,缝皮开始停用丙泊酚、瑞芬太尼,术中持续泵注右美托咪定1 μg·kg^-1·h^-1至监护室。术毕采用0.375％罗哌卡因行肋间神经阻滞、切口及引流口皮下局部浸润。静脉给予氨茶碱2～4 mg/kg、清理呼吸道并以SIMV模式诱导自主呼吸,手术结束后10 min内在手术室拔除气管导管,面罩吸氧送ICU。传统麻醉组患儿采用常规麻醉
方法 ,手术结束后带管直接送ICU。记录拔管时间、ICU留观时间及术后住院时间,记录术后拔管时、术后6、12、24 h躁动评分(SAS)及术后不良反应(气道梗阻)发生情况。
结果 超快通道组拔管时间、ICU留观时间和术后住院时间明显短于传统麻醉组（P<0.05）。超快通道组拔管时SAS评分明显低于传统麻醉组(P<0.05),术后6、12、24 h两组SAS评分差异无统计学意义。两组术后均无一例气道梗阻发生。
结论 与传统麻醉组比较,超快通道麻醉用于低体重CHD患儿可缩短术后拔管时间、ICU留观时间及术后住院时间,但不增加术后不良反应(气道梗阻及躁动)的发生率。

英文摘要:

      
Objective To observe the effect of ulinastatin on the expression of S100β protein and neuron-specific enolase (NSE) in infants undergoing corrective surgery for tetralogy of Fallot (TOF).
Methods Forty cases of TOF, 25 males and 15 females, undergoing elective corrective operations for cardiopulmonary bypass were randomly divided into two groups (n=20 each): ulinastatin group (group U) and control group (group C). Routine general anesthesia procedures were administered to both groups while the group U was treated with ulinastatin. Ulinastatin 10 000 U/kg was given from the right internal jugular vein after anesthesia induction, and ulinastatin 20 000 U/kg was given to the extracorporeal circulation priming liquid. On the first day after the operation, ulinastatin was continued for 30 000 U·kg^-1·d^-1, until the infant met the conditions of the withdrawal from ICU. Venous blood samples 3 ml were extracted after induction (T1), 30 min after CPB (T2), 24 h after the end of the operation (T3) and 48 h after the end of the operation (T4). The blood plasma was centrifugated so that S100β protein and NSE concentration was determinated with ELISA.
Results Serum S100β protein and NSE concentration of the two groups of patients at T1 was in normal level. The concentration of S100β protein and NSE of both groups reached the peak value at T2, and the difference was statistically significant compared with T1 (P < 0.05), then the concentration of S100β protein decreased slowly at T3—T4. The level of S100β protein was statistically different between T3—T4 and T1 while the level of NSE was statistically different between T3 and T1 (P < 0.05). The concentration of NSE returned to the preoperative level at T4.
Conclusion During the corrective operation for TOF in infant, increasing plasma S100β protein and NSE concentration can be inhibited by ulinastatin which may result in a certain degree of brain protection effect.