45例格林手术治疗复杂先天性心脏病麻醉管理.doc

45例格林手术治疗复杂先天性心脏病麻醉管理 　 作者：蒋怡燕，乔彬，吴莉莉，王振祥， 鞠吉峰，徐军，林晓娜 【摘要】 　　目的 探讨45例格林手术治疗复杂先天性心脏病的麻醉管理。方法 2005年1月至2007年6月我心研所采取单侧双向或双侧双向格林术式治疗复杂先天性心脏病共45例，年龄4个月～12岁，体重6～28 kg。麻醉均采用气管插管静脉复合麻醉。体重＜10 kg的患儿术前给口服咪达唑仑糖浆0.5 mg/kg镇静。＞10 kg的肌注安定0.02～0.03 mg/kg，东莨菪碱0.02～0.04 mg/kg。麻醉诱导采用静脉注射芬太尼5～10 μg/kg，维库溴铵0.1～0.15 mg/kg，依托咪酯0.2 mg/kg。右侧颈内置入双腔静脉导管。测CVP，左侧桡动脉穿刺测血压。麻醉维持用芬太尼10 μg/kg，维库溴铵0.1 mg/kg。在心包打开后在右心房内植入24号套管针建立临时通道连接延长管，在手术开始后视心率、血压变化泵入多巴胺3～5 μg /（kg·min）、硝酸甘油0.2～0.3 μg/（kg·min）或肾上腺素0.02～0.05 μg /（kg·min），同时在上腔静脉远心端与右心房“建桥”，建立临时旁路。纠正酸血症， BE＞-3给予碳酸氢钠1 ml/kg调整。结果 本组手术循环、麻醉处理稳定，无并发症、死亡。术后平均1～2 h意识恢复，2～4 h拔掉气管插管，脱离呼吸机。结论 麻醉处理得当，维持循环平稳，能保障手术顺利完成。 【关键词】 单侧双向或双侧双向格林术　婴儿　麻醉管理 Abstract: OBJECTIVE To investigate the anesthesia management of 45 Gleen operation for complex congenital heart disease(CHD). METHODS 45 complex CHD were treated using bidirectional or bilateral bidirectional Gleen operation from Jan. 2005 to Jun. 2007. The age ranged from 4 months to 12 years, weighting 6-28kg. Combined anesthesia was used for all the children. To those weighted less than 10kg midazolam was given orally 0.5 mg/kg and, to those weighted more than 10kg diazepam was injected 0.02-0.03 mg/kg with scopolamine 0.02-0.04 mg/kg before operation. Anesthesia was induced with fentanyl 5～10μg/kg, vecuronium 0.1-0.15 mg/kg, etomidate 0.2 mg/kg and maintained by fentanyl 10μg/kg, vecuronium 0.1 mg/kg. According to the heart rate and blood pressure,dopamine 3-5μg /（kg·min）, nitroglycerin 0.2-0.3μg /（kg·min） or Adrenaline 0.02-0.05μg/（kg·min） were used. Temporary bypass between central vein and right atria was constructed intraoperatively. The acidemia was corrected in time. RESULTS The circulation of all the children was stable and none with complication or death. After the operation, their consciousness recovered in 1-2 hours and withdrawal from mechanical ventilation in 2-4 hours. CONCLUSION The appropriate anesthesia and the stable circulation are important for the success of the operation . Key words： Bidirect