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目的探讨小儿主动脉瓣成形术的麻醉处理方法。方法 32例5～14岁行主动脉瓣成形术的先天性主动脉瓣狭窄患儿,采用静吸复合全麻及低温体外循环行主动脉瓣成形术,探讨这类患儿的麻醉处理方法。结果 2例麻醉前用药引起血压下降,6例在麻醉诱导时平均动脉压下降至45mmHg以下,5例在打开主动脉阻断钳5min后心脏才复跳。32例患者全部顺利送入ICU,最后治愈出院。平均带管时间(15.2±8.3)h,ICU停留时间为(2.2±0.8)d,术后住院时间(8.6±1.7)d。结论①术前用药剂量宜偏小。②维持窦性心率很重要。③心率最好维持在70～90次/min。④在可能情况下要适当提高前负荷,保持足够血容量,以增加每搏输出量。⑤最好不使用增强心肌收缩力或增加室壁张力的药物。⑥主动脉阻断时间不宜太长。
Objective To investigate the method of anesthesia in pediatric aortic valvuloplasty. Methods Thirty-two children with congenital aortic stenosis undergoing aortic valvuloplasty from 5 to 14 years old underwent aortic valvuloplasty under general anesthesia and hypothermic cardiopulmonary bypass. Results The blood pressure was decreased in 2 patients before anesthesia. In 6 patients, the mean arterial pressure dropped below 45mmHg at the time of induction of anesthesia. In 5 patients, the heart resumed after opening the aorta occlusion forceps for 5min. All 32 patients were successfully delivered to the ICU, and finally cured and discharged. The mean duration of catheterization was (15.2 ± 8.3) h. The ICU stay time was (2.2 ± 0.8) days and the postoperative hospital stay was (8.6 ± 1.7) days. Conclusion ① Preoperative dose should be small. ② maintain sinus heart rate is very important. ③ heart rate is best maintained at 70 to 90 beats / min. ④ When possible, to increase the preload, maintain adequate blood volume, in order to increase stroke volume. ⑤ best not to use to enhance myocardial contractility or increase the wall tension of drugs. ⑥ aorta blocking time should not be too long.