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目的 研究麻醉和心内直视手术对小儿自主神经的影响。方法 2 0例ASAⅠ～Ⅱ先天性心脏病手术的患儿。麻醉诱导 :羟丁酸钠 80～ 10 0mg/kg ,芬太尼 3μg/kg ,潘龙 0 0 8～ 0 1mg/kg ,气管插管。麻醉维持 :芬太尼切皮前总量达到 30 μg /kg ,于转机前和停机后静脉注射 10 μg /kg。潘龙 0 1mg/kg分别于切皮、转机前、停机后静脉注射。羟丁酸钠于转机前停机后静脉注射 4 0mg/kg。体外循环 :西京鼓泡式氧合器 ,改良托马液 15～2 0ml/kg主动脉灌注。主动脉阻断时间 ( 4 6± 2 4 )min ,转机时间 ( 81± 31)min。监测术前、切皮前、体外前、停机后、关胸后、术后 1d、术后 2d的低频、高频、总频、低频 /高频以及术中各时点脑电双频指数 (BIS)值。结果 与切皮时比较 ,体外循环后心率变异性各值明显减低 ,P <0 0 5。与手术前比较 ,手术后当日、术后 1、2d心率变异性各值减低并逐渐恢复 ,P <0 0 5。结论 麻醉、体外循环、手术操作以及低温对患儿的自主神经系统有较大的抑制作用 ,并持续到 2d以上。
Objective To study the effects of anesthesia and open heart surgery on autonomic nervous system in children. Methods 20 children with ASA Ⅰ ~ Ⅱ congenital heart surgery. Anesthesia induction: sodium oxybate 80 ~ 100mg / kg, fentanyl 3μg / kg, Panlong 0 0 8 ~ 0 1mg / kg, tracheal intubation. Anesthesia Maintenance: The total amount of fentanyl before incision reached 30 μg / kg and was intravenously injected with 10 μg / kg before and after shutdown. Panlong 0 1mg / kg, respectively, in the skin cut, before the transfer, stop after intravenous injection. Sodium oxybate in transit stop before intravenous injection of 40mg / kg. Cardiopulmonary bypass: Xijing bubbling oxygenator, modified Thomas liquid 15 ~ 20ml / kg aortic perfusion. Aorta blocking time (46 ± 2 4) min, turnaround time (81 ± 31) min. The preoperative, pre-cutaneous, pre-vitro, post-shutdown, closed chest, postoperative 1d, postoperative 2d low frequency, high frequency, total frequency, low frequency / high frequency and intraoperative EEG dual frequency index BIS) value. Results Compared with skin incision, the value of heart rate variability after cardiopulmonary bypass was significantly reduced, P <0 05. Compared with those before operation, the values of heart rate variability on the day after surgery and on the 1st and 2nd postoperative days were both decreased and gradually recovered (P <0.05). Conclusion Anesthesia, cardiopulmonary bypass, surgical operation and hypothermia have a greater inhibitory effect on the autonomic nervous system in children and persist to more than 2 days.