45例格林手术治疗复杂先天性心脏病的麻醉管理.doc

文档介绍：45例格林手术治疗复杂先天性心脏病的麻醉管理
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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 mg/kg镇静。>10 ~ mg/kg,~ mg/kg。麻醉诱导采用静脉注射芬太尼5~10 μg/kg,~ mg/kg, 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, 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)、~ μg/(kg·min)~
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 plex congenital heart disease(CHD). METHODS plex 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 mg/kg and, to those weighted more than 10kg diazepam was injected - mg/kg with scopolamine - mg/kg before operation. Anesthesia was induced with fentanyl 5~10μg/kg, vecuronium - mg/kg, etomidate mg/kg and maintained by fentanyl 10μg/kg, vecuronium