摘要
目的 本研究拟探讨小儿复杂先天性心脏病 (先心病 )手术后经左房给儿茶酚胺类药物的可行性。方法 从 19例手术治疗的复杂先心病患儿中 ,随机抽取 6例经左房输注儿茶酚胺 ,其余患儿采取经中心静脉给药。手术前经右颈内静脉安放Swan Ganz导管 ,待术中放入肺动脉。左房给药组患儿 ,穿刺右锁骨下静脉置入 30cm长的 4号深静脉管 ,待手术中经卵圆孔或房间隔缺损放入左房 ,作为手术后经左房给药的通路。两组患儿均在开放循环后 ,分别经左房或中心静脉 ,立即输注多巴胺和多巴酚丁胺 ,剂量为 6～ 10 μg·kg- 1 ·min- 1 ,持续 3d后逐渐减量。分别于停机后即刻及术后 2、4、8、16、2 4、36、48、72h经Swan Ganz导管测量右房压、平均肺动脉压、肺毛嵌顿压 ,用热稀释法测量心输出量 ,然后计算出体循环阻力和肺血管阻力。结果 经左房给药组手术后肺动脉压力及肺血管阻力显著低于经中心静脉给药组 (P <0 0 5 ) ,手术后左房给药组心指数与中心静脉给药组相比无统计学意义 ,两组患儿的其它血液动力学指标无显著差异 (P >0 0 5 )。结论 复杂先心病术后经左房输注正性肌力药物能消除经中心静脉给药引起的肺动脉压力及肺血管阻力升高。
Objective To discuss the feasibility of administrative catecholamines via the left atrial after cardiac surgery in children with complex congenital heart disease Methods Ninteen children with complex congenital heart disease undergoing cardiac surgery,were randomly allocated to be infused with dopamine and dobutamine 6 10μg·kg -1 ·min -1 through the left atrial (left atrial group,n=6) or through the central vein (central venous group,n=13) following the declamping ,respectively The Swan Ganz catheters were inserted via right internal jugular vein before operation and were put into pulmonary artery during operation A 4F deep venous catheter of 30 cm length was inserted via right subclavian vein and were put into the left atrial via FO or ASD during operation Hemodynamic parameters were measured with Swan Ganz catheter technique immediately after weaning from CPB and 2, 4, 8, 16, 24, 36, 48, and 72 h after cardiac surgery Results The average pulmonary arterial pressures(MPAP) and pulmonary vascular resistances (PVR)in the central venous group were higher than those in left atrial group(P<0 05) There were not significant differences in other parameters between both groups Conclusions Left atrial catecholamines administration can prevent the increase of MPAP and PVR,induced with the central venous catecholamines, from occurrance after cardiac surgery in children with complex congenital heart disease
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2000年第4期204-206,共3页
Chinese Journal of Anesthesiology
关键词
先天性心脏病
手术后
儿茶酚胺
输注
儿童
Child
Heart defects,congenital
Catecholamines
Hemodynamics
Heart atrium
Drug administration routes
