新生儿先天性心脏病手术的麻醉管理_医学论文.docVIP

新生儿先天性心脏病手术的麻醉管理_医学论文 新生儿先天性心脏病手术的麻醉管理_医学论文 作者：陈敏　李杰　张英民　侯立朝　熊利泽 【关键词】 先天性心脏病 关键词: 新生儿先天性心脏病麻醉 摘 要:目的 探讨适合新生儿特点的先天性心脏病手术麻醉管理方法. 方法 10例先天性心脏病患儿年龄9～27（平均13）d，体质量2.8～5.0（平均3.7）kg.术前积极治疗肺炎、心力衰竭和水、电解质平衡紊乱.快速诱导后行气管内插管、机械通气建立有创血液动力学监测采用静吸复合维持麻醉体外循环下进行心脏畸形矫治术手术结束后在监护病房继续行机械通气，待患儿意识清醒、肌力和呼吸恢复正常后拔出气管内导管. 结果 麻醉前有2例患儿在监护室即行气管内插管，1例术前静滴前列腺素E1（0.05μg#12539kg-1 #12539min-1 ）全组均采用经鼻插入气管导管，采用CMV+PEEP0.4kPa行机械通气9例在心内手术完成后心脏均自动复跳并停用体外循环机，另1例患儿因左室发育差，未能停机心脏自动复跳后常规用多巴胺2～8μg#12539kg-1 #12539min-1 、硝普钠0.1～0.5μg#12539kg-1 #12539min-1 部分需用异丙肾上腺素0.01～0.02μg#12539kg-1 #12539min-1 或肾上腺素0.01μg#12539kg-1 #12539min-1 ，前列腺素0.05μg#12539kg-1 #12539min-1 以维持循环稳定术后1例死于未停机，另1例死于肺部并发症，其余8例均在术后4～6h时拔管，恢复顺利，术后10d出院. 结论 术前对患儿病情的正确评估，选用正确的麻醉手术方法，术后加强监护是新生儿先天性心脏病手术成功的关键. 　　Keywords:infant，newborncongenital heart diseaseanes-thesia Abstract:AIM To study anesthetic management for open-heart surgery on newborns with congenital heart disease.METHODS Ten newborns，aged13（9～27）d with body weight3.7（2.8～5.0）kg，scheduled for elective open-heart surgery，were included in this study.Pneumonitis，heart fail-ure and imbalance of fluid and electrolyte were treated before operation.Fast induction sequence was taken，followed by endotracheal intubation and mechanical ventilation.And then invasive hemodynamic monitoring was done.Combined anes-thesia of intravenous and inhaled anesthesia were set to main-tain anesthesia for the whole surgical procedure.Mechanical ventilation was continued in intensive care unit after opera-tion.Endotracheal tube was extubated when the newborns regained consciousness muscle force and normal respiration.RESULTS Before anesthesia，2newborns received endotra-cheal intubation in the intensive care unit，1newborn was given intravenous prostaglandin E1（0.05μg#12539kg-1 #12539min-1 ）Endotracheal tube was intubated through nose in all newborns，and CMV+PEEP0.4kPa was applied for me-chanical ventilation9newborns regained automatic heart beat after intracardiac operation，and cardiopulmonary bypass