Laird Tracy H, Stayer Stephen A, Rivenes Shannon M, Lewin Mark B, McKenzie E Dean, Fraser Charles D, Andropoulos Dean B
Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, 6621 Fannin, Houston, TX 77030-2399, USA.
Anesth Analg. 2002 Nov;95(5):1200-6, table of contents. doi: 10.1097/00000539-200211000-00016.
The cardiovascular effects of volatile anesthetics in children with congenital heart disease have been studied, but there are limited data on the effects of anesthetics on pulmonary-to-systemic blood flow ratio (Qp:Qs) in patients with intracardiac shunting. In this study, we compared the effects of halothane, isoflurane, sevoflurane, and fentanyl/midazolam on Qp:Qs and myocardial contractility in patients with atrial (ASD) or ventricular (VSD) septal defects. Forty patients younger than 14 yr old scheduled to undergo repair of ASD or VSD were randomized to receive halothane, sevoflurane, isoflurane, or fentanyl/midazolam. Cardiovascular and echocardiographic data were recorded at baseline, randomly ordered 1 and 1.5 mean alveolar anesthetic concentration (MAC) levels, or predicted equivalent fentanyl/midazolam plasma levels. Ejection fraction (using the modified Simpson's rule) was calculated. Systemic (Qs) and pulmonary (Qp) blood flow was echocardiographically assessed by the velocity-time integral method. Qp:Qs was not significantly affected by any of the four regimens at either anesthetic level. Left ventricular systolic function was mildly depressed by isoflurane and sevoflurane at 1.5 MAC and depressed by halothane at 1 and 1.5 MAC. Sevoflurane, halothane, isoflurane, or fentanyl/midazolam in 1 or 1.5 MAC concentrations or their equivalent do not change Qp:Qs in patients with isolated ASD or VSD.
Sevoflurane, halothane, isoflurane, and fentanyl/midazolam do not change pulmonary-to-systemic blood flow ratio in children with atrial and ventricular septal defects when administered at standard anesthetic doses with 100% oxygen.
已对挥发性麻醉剂对先天性心脏病患儿的心血管影响进行了研究，但关于麻醉剂对心内分流患者肺循环与体循环血流量比值（Qp:Qs）影响的数据有限。在本研究中，我们比较了氟烷、异氟烷、七氟烷以及芬太尼/咪达唑仑对房间隔缺损（ASD）或室间隔缺损（VSD）患者Qp:Qs及心肌收缩力的影响。40例计划接受ASD或VSD修补术的14岁以下患者被随机分为接受氟烷、七氟烷、异氟烷或芬太尼/咪达唑仑组。在基线、随机安排的1个和1.5个平均肺泡麻醉浓度（MAC）水平或预测的等效芬太尼/咪达唑仑血浆水平时记录心血管和超声心动图数据。计算射血分数（采用改良Simpson法则）。通过速度 - 时间积分法超声心动图评估体循环（Qs）和肺循环（Qp）血流量。在任一麻醉水平下，四种方案中的任何一种对Qp:Qs均无显著影响。异氟烷和七氟烷在1.5 MAC时轻度抑制左心室收缩功能，氟烷在1 MAC和1.5 MAC时抑制左心室收缩功能。七氟烷、氟烷、异氟烷或1个或1.5个MAC浓度的芬太尼/咪达唑仑及其等效剂量不会改变单纯ASD或VSD患者的Qp:Qs。
当以100%氧气按标准麻醉剂量给药时，七氟烷、氟烷、异氟烷和芬太尼/咪达唑仑不会改变房间隔和室间隔缺损患儿的肺循环与体循环血流量比值。
