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目的:观察、比较七氟醚吸入麻醉与全凭静脉麻醉在小儿先天性心脏病手术中的应用。方法:40例择期行先天性心脏病房室缺矫治术患儿,随机分为七氟醚组和全凭静脉麻醉组(TIVA组),每组各20例。七氟醚组患儿以七氟醚吸入诱导,复合小剂量芬太尼、咪达唑仑、维库溴铵,麻醉维持为七氟醚吸入+芬太尼、维库溴铵;静脉组患儿肌注氯胺酮后,以芬太尼、咪达唑仑、维库溴铵诱导,维持使用丙泊酚持续泵入+芬太尼、维库溴铵。比较两组术中各时点血流动力学变化、手术麻醉时间与芬太尼、维库溴铵用量、术后呼吸支持时间、清醒时间、拔管时间,比较两组不良反应发生情况。结果:两组患儿均维持比较稳定的血流动力学状态。七氟醚组芬太尼与维库溴铵用量明显低于TIVA组,呼吸支持时间、清醒时间、拔管时间明显低于TIVA组。七氟醚组2例术后发生躁动,3例发生恶心,稍高于TIVA组。结论:七氟醚应用于小儿先心房室缺矫治术,可提供稳定的血流动力学状态,并降低芬太尼与肌松剂用量,实现术后早拔管、改善患者预后、降低医疗费用。
Objective: To observe and compare the application of sevoflurane inhalation anesthesia and total intravenous anesthesia in children with congenital heart disease. Methods: Forty children undergoing atrioventricular tachycardia with congenital heart disease were randomly divided into sevoflurane group and total intravenous anesthesia group (TIVA group), 20 cases in each group. Sevoflurane group induced by inhalation of sevoflurane, combined with small doses of fentanyl, midazolam, vecuronium, anesthesia was maintained for sevoflurane + fentanyl, vecuronium; vein group After intramuscular injection of ketamine, with fentanyl, midazolam, vecuronium induction, sustained use of propofol pump + continuous infusion of fentanyl, vecuronium. The changes of hemodynamics, operative anesthesia time, the dosage of fentanyl, vecuronium, postoperative respiratory support time, awake time and extubation time were compared between the two groups. The occurrence of adverse reactions in both groups were compared. Results: Both groups maintained stable hemodynamic status. Sevoflurane fentanyl and vecuronium dosage was significantly lower than the TIVA group, respiratory support time, awake time, extubation time was significantly lower than the TIVA group. Two patients in sevoflurane group had agitation after operation, 3 patients had nausea, slightly higher than TIVA group. CONCLUSIONS: Sevoflurane is used in children with atrial premature ventricular septal defect, which can provide stable hemodynamic status, reduce the dosage of fentanyl and muscle relaxants, achieve early postoperative extubation, improve patient prognosis and reduce medical costs .