吸入七氟醚麻醉诱导对抑制先天性心脏病患儿气管插管应激反应的效果。

Efficacy of inhalational sevoflurane anesthesia induction on inhibiting the stress response to endotracheal intubation in children with congenital heart disease.

机构信息

Department of Anesthesiology, Yantaishan Hospital, Yantai, Shandong Province, China.

出版信息

Eur Rev Med Pharmacol Sci. 2018 Feb;22(4):1113-1117. doi: 10.26355/eurrev_201802_14399.

DOI:10.26355/eurrev_201802_14399

PMID:29509264

Abstract

OBJECTIVE

To investigate the efficacy of inhalational sevoflurane anesthesia induction on inhibiting the stress response to endotracheal intubation in pediatric patients with congenital heart disease (CHD).

PATIENTS AND METHODS

Forty ASA physical status I/II pediatric patients scheduled for interventricular septal defect repair or interatrial septal defect repair, were randomly divided into two groups (20 each): intravenous induction group (Group C) and inhalational sevoflurane anesthesia induction group (Group D). In group C, anesthesia was induced with midazolam, pipecuronium bromide and fentanyl, and the children were examined by radial artery monitoring after the consciousness extinction. Also, they were endotracheally intubated after muscle relaxation. In group D, anesthesia was induced with inhalation of 8% sevoflurane and 6 L/min oxygen, and the children were examined by radial artery monitoring after the consciousness extinction and were endotracheally intubated 4 min later. Before anesthesia induction (T0), consciousness extinction (T1), endotracheal intubation (T2), endotracheal intubation (T3), and after endotracheal intubation (T4), 1 and 3 min after intratracheal intubation (T5,6), HR and bispectral index (BIS) were monitored. The MAP of T2-T6 points was recorded. Ulnar vein blood samples were taken for determination of Endothelin (ET) and Thromboxane A2(TXA2) in the points of consciousness extinction, and 5 and 10 min after endotracheal.

RESULTS

All the children were well examined by endotracheal intubation. Compared with the baseline value at T0, there was no significant difference of HR in group D, but the HR of group C was decreased at T2, T3, T4 and T6. The BIS of the two groups were decreased at T1-T6 (p<0.05). Compared with the values at T2, they were increased at T5 and T6 in group C, and increased at T6 in group D (p<0.05). Compared with group C, the MAP of group D was decreased at T5, and the BIS of the two groups was decreased at T2-T6 (p<0.05). There were no significant differences of ET and TXA2 between groups.

CONCLUSIONS

It is well inhibited the endotracheal intubation stress response in children with congenital heart diseases using sevoflurane inhalational anesthesia induction.

摘要

目的

探讨吸入七氟醚麻醉诱导对小儿先天性心脏病（CHD）患者气管插管应激反应的抑制作用。

方法

选择择期行室间隔缺损修补术或房间隔缺损修补术的 ASA Ⅰ/Ⅱ级小儿患者 40 例，随机分为两组（每组 20 例）：静脉诱导组（C 组）和吸入七氟醚麻醉诱导组（D 组）。C 组麻醉诱导用咪达唑仑、哌库溴铵和芬太尼，意识消失后行桡动脉监测，待肌松后行气管插管。D 组麻醉诱导用 8%七氟醚和 6 L/min 氧气吸入，意识消失后行桡动脉监测，4 min 后行气管插管。分别于麻醉诱导前（T0）、意识消失时（T1）、气管插管时（T2）、气管插管后即刻（T3）、气管插管后 1 min（T4）、气管插管后 3 min（T5）、气管插管后 1 min（T6）监测心率（HR）和脑电双频指数（BIS）。记录 T2-T6 点的平均动脉压（MAP）。在意识消失时、气管插管后 5 min 和 10 min 时取尺静脉血样，测定内皮素（ET）和血栓素 A2（TXA2）。

结果

两组患儿均顺利完成气管插管检查。与 T0 时的基础值相比，D 组的 HR 无明显变化，但 C 组的 HR 在 T2、T3、T4 和 T6 时降低。两组的 BIS 在 T1-T6 时均降低（p<0.05）。与 T2 时相比，C 组在 T5 和 T6 时升高，D 组在 T6 时升高（p<0.05）。与 C 组相比，D 组在 T5 时 MAP 降低，两组在 T2-T6 时 BIS 降低（p<0.05）。两组 ET 和 TXA2 无明显差异。