Chakravarthy Murali, Sunilkumar Gubbihalli, Pargaonkar Sumant, Hosur Rajathadri, Harivelam Chidananda, Kavaraganahalli Deepak, Srinivasan Pradeep
Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India.
Ann Card Anaesth. 2015 Apr-Jun;18(2):179-84. doi: 10.4103/0971-9784.154471.
The purpose of our study was to determine the effect of induced apnea on quality of cardiopulmonary structures during computerized tomographic (CT) angiography images in children with congenital heart diseases.
Pediatric patients with congenital heart defects undergoing cardiac CT angiography at our facility in the past 3 years participated in this study. The earlier patients underwent cardiac CT angiography without induced apnea and while, later, apnea was induced in patients, which was followed by electrocardiogram gated cardiac CT angiography. General anesthesia was induced using sleep dose of intravenous propofol. After the initial check CT, on request by the radiologist, apnea was induced by the anesthesiologist by administering 1 mg/kg of intravenous suxamethonium. Soon after apnea ensued, the contrast was injected, and CT angiogram carried out. CT images in the "apnea group" were compared with those in "nonapnea group." After the completion of the procedure, the patients were mask ventilated with 100% oxygen till the spontaneous ventilation was restored.
We studied 46 patients, of whom 36 with apnea and yet another 10 without. The quality of the image, visualization of structures such as cardiac wall, outflow tracts, lung field, aortopulmonary shunts, and coronary arteries were analyzed and subjected to statistical analysis (Mann-Whitney U, Fischer's exact test and Pearson's Chi-square test). In the induced apnea group, overall image quality was considered excellent in 89% (n = 33) of the studies, while in the "no apnea group," only 30% of studies were excellent. Absent or minimal motion artifacts were seen in a majority of the studies in apnea group (94%). In the nonapnea group, the respiratory and body motion artifacts were severe in 50%, moderate in 30%, and minimal in 20%, but they were significantly lesser in the apnea group. All the studied parameters were statistically significant in the apnea group in contrast to nonapnea group (P < 0.000).
The image quality of cardiac CT angiography greatly improves, and motion artifact significantly decreases with the use of induced apnea in pediatrics patients being evaluated for congenital heart disease. This technique poses no additional morbidity of significance.
我们研究的目的是确定在先天性心脏病患儿的计算机断层扫描（CT）血管造影图像中，诱导性呼吸暂停对心肺结构质量的影响。
过去3年内在我们机构接受心脏CT血管造影的先天性心脏病儿科患者参与了本研究。早期患者在未诱导呼吸暂停的情况下接受心脏CT血管造影，而后来患者在诱导呼吸暂停后，接着进行心电图门控心脏CT血管造影。使用静脉注射丙泊酚的睡眠剂量诱导全身麻醉。在初始检查CT后，应放射科医生的要求，麻醉医生通过静脉注射1mg/kg的琥珀酰胆碱诱导呼吸暂停。呼吸暂停出现后不久，注射造影剂并进行CT血管造影。将“呼吸暂停组”的CT图像与“非呼吸暂停组”的图像进行比较。检查完成后，用100%氧气对患者进行面罩通气，直至恢复自主通气。
我们研究了46例患者，其中36例诱导了呼吸暂停，另外10例未诱导。分析了图像质量、心脏壁、流出道、肺野、主肺动脉分流和冠状动脉等结构的可视化情况，并进行了统计分析（曼-惠特尼U检验、费舍尔精确检验和皮尔逊卡方检验）。在诱导呼吸暂停组中，89%（n = 33）的研究中总体图像质量被认为优秀，而在“无呼吸暂停组”中，只有30%的研究是优秀的。在呼吸暂停组的大多数研究中（94%）可见无或最小的运动伪影。在非呼吸暂停组中，呼吸和身体运动伪影严重的占50%，中度的占30%，最小的占20%，但在呼吸暂停组中明显较少。与非呼吸暂停组相比，呼吸暂停组中所有研究参数均具有统计学意义（P < 0.000）。
在对先天性心脏病患儿进行评估时，使用诱导性呼吸暂停可显著提高心脏CT血管造影的图像质量，并显著减少运动伪影。该技术不会带来额外的显著发病率。
