Ikemba Catherine M, Su Jason T, Stayer Stephen A, Miller-Hance Wanda C, Eidem Benjamin W, Bezold Louis I, Hall Stuart R, Havemann Luke M, Andropoulos Dean B
Section of Pediatric Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Dallas, Texas, USA.
Anesthesiology. 2004 Dec;101(6):1298-305. doi: 10.1097/00000542-200412000-00009.
Patients with congenital heart disease characterized by a functional single ventricle make up an increasing number of patients presenting for cardiac or noncardiac surgery. Conventional echocardiographic methods to measure left ventricular function, i.e., ejection fraction, are invalid in these patients because of altered ventricular geometry. Two recently described Doppler echocardiographic modalities, the myocardial performance index and Doppler tissue imaging, can be applied to single-ventricle patients because they are independent of ventricular geometry. This study assessed the changes in myocardial performance index and Doppler tissue imaging in response to two anesthetic regimens, fentanyl-midazolam-pancuronium and sevoflurane-pancuronium.
Thirty patients aged 4-12 months with a functional single ventricle were randomized to receive fentanyl-midazolam or sevoflurane. Myocardial performance index and Doppler tissue imaging were measured by transthoracic echocardiography at baseline and two clinically relevant dose levels.
Sixteen patients receiving sevoflurane and 14 receiving fentanyl-midazolam were studied. Myocardial performance index was unchanged from baseline with either agent (fentanyl-midazolam: 0.50 +/- 15 baseline vs. 0.51 +/- 0.15 at dose 2; sevoflurane: 0.42 +/- 0.14 baseline vs. 0.46 +/- 0.09 at dose 2). Doppler tissue imaging S (systolic)- and E (early diastolic)-wave velocities in the lateral ventricular walls at the level of the atrioventricular valve annulus were unchanged in the sevoflurane group; however, both Doppler tissue imaging S- and E-wave velocities were decreased significantly from baseline at dose 1 and dose 2 with fentanyl-midazolam, consistent with decreased longitudinal systolic and diastolic ventricular function.
Myocardial performance index, a global measurement of combined systolic and diastolic ventricular function, is not affected by commonly used doses of fentanyl-midazolam or sevoflurane in infants with a functional single ventricle.
以功能性单心室为特征的先天性心脏病患者在接受心脏或非心脏手术的患者中所占比例日益增加。由于心室几何形状改变，传统超声心动图测量左心室功能（即射血分数）的方法在这些患者中无效。最近描述的两种多普勒超声心动图方法，心肌性能指数和多普勒组织成像，可应用于单心室患者，因为它们不受心室几何形状的影响。本研究评估了两种麻醉方案（芬太尼-咪达唑仑-潘库溴铵和七氟醚-潘库溴铵）对心肌性能指数和多普勒组织成像的影响。
30例4至12个月大的功能性单心室患者被随机分为接受芬太尼-咪达唑仑或七氟醚治疗。在基线和两个临床相关剂量水平通过经胸超声心动图测量心肌性能指数和多普勒组织成像。
研究了16例接受七氟醚治疗和14例接受芬太尼-咪达唑仑治疗的患者。两种药物治疗后心肌性能指数均与基线无变化（芬太尼-咪达唑仑：基线时0.50±0.15，剂量2时0.51±0.15；七氟醚：基线时0.42±0.14，剂量2时0.46±0.09）。七氟醚组房室瓣环水平外侧心室壁的多普勒组织成像S（收缩期）波和E（舒张早期）波速度无变化；然而，芬太尼-咪达唑仑治疗在剂量1和剂量2时，多普勒组织成像S波和E波速度均较基线显著降低，这与心室纵向收缩和舒张功能降低一致。
心肌性能指数是心室收缩和舒张功能的综合整体测量指标，不受功能性单心室婴儿常用剂量的芬太尼-咪达唑仑或七氟醚的影响。
