Spaeth J P, O'Hara I B, Kurth C D
Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine, 19104, USA.
Semin Perinatol. 1998 Oct;22(5):390-401. doi: 10.1016/s0146-0005(98)80055-4.
Providing anesthesia for the micropremie involves many considerations beyond what is needed for the full-term neonate. Immaturity of the airway, lungs, cardiovascular system, liver, kidneys, and central nervous system makes the micropremie susceptible to anesthestic complications. Immature respiratory mechanisms and respiratory control increase the risk of apnea, hypoxemia, and hypercapnia intraoperatively as well as postoperatively. Anesthetic drugs depress myocardial contractility and impair baroreflexes in the micropremie to increase the risk of hypotension during anesthesia. Drug metabolism in the micropremie is slow because of the immature liver and kidneys. The micropremie brain requires less drug to achieve the anesthetized state. As a result, administration of the dose and timing of anesthetic drugs differs in the micropremie compared with the full-term neonate. This article describes anesthetic considerations for a few surgical prodedures common in the micropremie.
为超低出生体重儿提供麻醉需要考虑许多因素，这些因素超出了足月儿麻醉所需的范畴。气道、肺、心血管系统、肝脏、肾脏及中枢神经系统发育不成熟，使得超低出生体重儿易发生麻醉并发症。不成熟的呼吸机制及呼吸控制增加了术中及术后呼吸暂停、低氧血症和高碳酸血症的风险。麻醉药物会抑制超低出生体重儿的心肌收缩力并损害压力反射，从而增加麻醉期间低血压的风险。由于肝脏和肾脏发育不成熟，超低出生体重儿的药物代谢缓慢。超低出生体重儿的大脑达到麻醉状态所需的药物较少。因此，与足月儿相比，超低出生体重儿麻醉药物的给药剂量和时机有所不同。本文介绍了一些超低出生体重儿常见外科手术的麻醉注意事项。
