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1 病例报告患儿男,14岁,体重32kg,因反复上消化道出血诊断为胃肠重复畸形、小肠憩室入院.患儿自幼活动后心悸、气短、口唇紫绀,营养状态差,贫血貌,杵状指,心功能Ⅲ级.查心界向右扩大,右侧心前区可闻及4～5级收缩期杂音,两肺未闻及干、湿罗音.实验室检查:Hb 469/L,RBC 1.88×10~(12)/L,Hct 0.17.ECG示不完全右束支传导阻滞,右室肥厚.胸透示右位心,心脏呈主动脉型,肺血流量增多.超声心动图示右位心,室间隔缺损,二尖瓣相对狭窄并关闭不全.全消化道钡剂造影示全内脏转位,十二指肠憩室.充分术前准备,抗生素预防感染,多次输新鲜血及支持治疗,使Hb达90g/L,RBC 3.7×10~(12)/L.麻醉前给安定8mg、哌替啶30mg、东莨菪碱0.2mg肌注.入手术室后测BP 12/8 kPa,HR 70次/分,R 24次/分,血氧饱和度(SPO_2)76%,呈重度缺氧状态.经面罩吸氧后,SPO_2升至90%,开始应用γ-OH2.5g及芬太尼0.1mg静脉缓慢诱导,待下颌松弛,经口腔表麻后插管,插管BP 13/8 kPa,HR 90次/分.术中用泮库溴铵维持肌肉松弛,控制呼吸,间断静注芬太尼0.1mg及间断吸入安氟醚.术中BP在13～15/10～8kPa,HR 90～110次/分,SPO_2 87%～99%.输血、输液800ml,手术历时2.5小时.术毕30分钟清醒拔管.拔管时SPO_2 87%,继续面罩吸氧,术后无麻
A case report of male, 14 years old, weighing 32kg, due to repeated upper gastrointestinal bleeding diagnosed as gastrointestinal duplication, admission to the small bowel diverticulum. Children with palpitations, shortness of breath, cyanotic lips, poor nutritional status, anemia appearance, Clubbing refers to the heart function Ⅲ level to check the heart to the right to expand the right precordial area can be heard and 4 to 5 systolic murmur, both lungs did not smell and wet rales. Laboratory tests: Hb 469 / L, RBC 1.88 × 10-12 / L, Hct 0.17.ECG showed incomplete right bundle branch block, right ventricular hypertrophy.The thoracentesis showed the right centripetal heart aortic type, pulmonary blood flow increased echocardiography Diagram shows the right centroid, ventricular septal defect, mitral valve is relatively narrow and closed incomplete .A total gastrointestinal barium angiography showed all visceral transposition, duodenal diverticulum .Preoperative preoperative preparation, antibiotics to prevent infection, many lose new Blood and supportive treatment, Hb up to 90g / L, RBC 3.7 × 10 ~ (12) / L. Before anesthesia to stable 8mg, meperidine 30mg, scopolamine 0.2mg intramuscular injection into the operating room measured BP 12/8 kPa , HR 70 beats / min, R 24 beats / min, blood oxygen saturation (SPO 2) 76%, a state of severe hypoxia.After oxygen inhalation by mask, SPO 2 increased to 90%, began to use γ-OH 2.5g and Fen Taiyuan 0.1mg slowly induced venous, to be Jaw relaxation, intubation after oral anesthesia, intubation BP 13/8 kPa, HR 90 beats / min intraoperative use of pancuronium bromide to maintain muscle relaxation, breathing control, intermittent intravenous fentanyl 0.1mg and intermittent inhalation Enflurane, intraoperative BP at 13 ~ 15/10 ~ 8kPa, HR 90 ~ 110 beats / min, SPO 2 87% ~ 99% .Transfusion, infusion 800ml, surgery lasted 2.5 hours. Tube SPO_2 87%, to continue oxygen mask, no postoperative hemp