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目的评价小儿心脏手术的麻醉管理技术应用于幼猪低温低流量体外循环(CPB)心脏手术的全麻效果及其安全性。方法普通幼猪42只,基础麻醉采用氯胺酮加硫酸阿托品肌肉注射,麻醉诱导和维持采用芬太尼、哌库溴铵和咪达唑仑静脉注射,并辅助吸入七氟烷;CPB全流量后停止机械通气,给予可调压力限制阀0.49 kPa压力静态膨肺,主动脉开放后吸痰,手控通气膨肺,恢复机械通气;根据动脉血气结果纠正内环境紊乱,复温期间泵入多巴胺、多巴酚丁胺维持循环稳定,心律失常根据其类型给予相应的处理;监测并记录血流动力学指标、动脉血气分析指标、呼吸参数、麻醉总时间、主动脉阻断时间、CPB转机时间。结果 1只死于CPB后心脏骤停,余41只完成至实验终点,主动脉阻断时间为(125±8)min,CPB转机时间为(184±10)min,麻醉总时间为(335±17)min。结论小儿心脏手术麻醉管理方法应用于幼猪低温低流量CPB心脏手术全麻效果满意,且安全性高。
Objective To evaluate the general anesthesia and safety of anesthesia management in pediatric cardiac surgery applied to cardiopulmonary bypass (CPB) in young pigs. Methods Forty-two piglets were injected intramuscularly with ketamine and atropine sulfate. The anesthesia was induced and maintained by intravenous injection of fentanyl, pipecuride and midazolam, and the inhalation of sevoflurane. CPB was stopped after the full flow Mechanical ventilation, to give an adjustable pressure limit valve 0.49 kPa pressure static expansion of the lungs, aortic suction after suction, manual ventilation inflation, recovery of mechanical ventilation; according to arterial blood gas results to correct the internal environment disorders, during rewarming pumped into dopamine, and more Cardioversion was maintained at a steady cycle. Arrhythmias were treated according to their type. Hemodynamic parameters, arterial blood gas analysis parameters, respiratory parameters, total anesthesia time, aortic cross-clamping time and CPB transit time were monitored and recorded. Results One died of cardiac arrest after CPB, and the remaining 41 were completed until the end of the experiment. The aortic blockade time was (125 ± 8) min, CPB transit time was (184 ± 10) min and total anesthesia time was (335 ± 17) min. Conclusion Anesthesia management in pediatric cardiac surgery is satisfactory and safe for general anesthesia of neonatal hypothermia and low-flow CPB cardiac surgery.