摘要
目的本研究旨在分析紫绀型与非紫绀型先心患儿术中动脉血与呼气末二氧化碳分压的差值（Pa-ETCO2）,评估过度通气对Pa-ETCO2的影响,分析七氟醚的浓度变化对Pa-ETCO2的影响。方法选择择期行心脏手术的患儿120例,男60例,女60例,年龄1个月-6岁,ASAⅡ或Ⅲ级,根据心脏内左向右或右向左分流按随机区组设计分为六组,每组20例：A1组,紫绀患儿接受0.5MAC七氟醚吸入麻醉;A2组,紫绀患儿接受1.0 MAC七氟醚吸入麻醉;B1组,非紫绀患儿接受0.5 MAC七氟醚吸入麻醉;B2组,非紫绀患儿接受1.0MAC七氟醚吸入麻醉;C1组,紫绀对照组,单纯静脉麻醉,不接受任何干预因素;C2组,非紫绀对照组,单纯静脉麻醉,不接受任何干预因素。所有患者开放动静脉后选择气管内插管全身麻醉。分别于切皮前、开胸行过度通气后（对照组不行过度通气）及关胸前5min记录患者的PETCO2、SpO2、PaCO2、SaO2、Hct及体温（鼻咽温和肛温）。结果切皮前,六组患儿Pa-ETCO2均大于正常值,且B1组明显小于A1组,B2组明显小于A2组,C2组明显小于C1组（P〈0.01）。与切皮前比较,过度通气后A1、A2、B1、B2组的Pa-ETCO2明显减小（P〈0.05或P〈0.01）。过度通气对非紫绀组的影响更明显。与切皮前比较,关胸前5min B1、B2、C2组的Pa-ETCO2明显增大（P〈0.01）,而A1、A2、C1组的Pa-ETCO2明显减小（P〈0.05）。A1组与A2组,B1组与B2组各时点Pa-ETCO2差异均无统计学意义。结论紫绀型先心患儿的Pa-ETCO2明显大于非紫绀型先心患儿,因此,在紫绀型先心患儿中加强对动脉血气分析的校正是十分重要的。过度通气可以明显减小非紫绀型先心患儿中的Pa-ETCO2,但对紫绀型先心患儿不建议使用。七氟醚在一定范围内浓度的增加不会影响Pa-ETCO2。
Objective To estimate the arterial-to-end-tidal carbon dioxide tension difference（Pa-ETCO2）in children with cyanotic or acyanotic congenital heart diseases;evaluate whether hyperventilation can reduce the tension difference or not;analyze the effect of sevofleurane on Pa-ETCO2.Methods One hundred and twenty patients（male 60 cases,female 60 cases,aged 1month-6years,ASA classⅡ orⅢ）undergoing selective cardiac surgery were randomly divided into 6groups（n=20each）based on right-to-left or left-to-right intracardic shunts：group A1,cyanotic with sevoflurane of0.5 MAC;group A2,cyanotic with sevoflurane of 1.0 MAC;group B1,acyanotic with sevoflurane of 0.5 MAC;group B2,acyanotic with sevoflurane of 1.0 MAC;group C1,cyanotic with no intervention factors;group C2,acyanotic with no intervention factors.All the children received general anaesthesia after placing an intravenous and arterial catheter.The value of PETCO2,SpO2,PaCO2,SaO2,Hct and temperature（nasopharyngeal temperature and rectal temperature）were obtained before operation,after hyperventilation（the control groups without hyperventilation）and five minutes before surture sternum.Results The values of Pa-ETCO2 were more than the normal one in six groups before operation.The value of Pa-ETCO2 in group B1 was less than that in group A1,that in group B2 was less than that in group A2 and that in group C2 was less than that in group C1 before operation（P〈0.01）.Compared with the time point before operation,the values of Pa-ETCO2 in groups A1,A2,B1 and B2decreased significantly after hyperventilation（P〈0.05 or P〈0.01）.Moreover,this reduction was more significant in groups B1 and B2.Compared with the time point before operation,the values of Pa-ETCO2 in groups B1,B2,C2 increased significantly（P〈0.01）and that in groups A1,A2,C1 decreased significantly（P〈0.05）at 5minutes before surture sternum.There was no statistical difference at three different time points between group A1 and A2,B1 and B2.Conclusion The value of Pa-ETCO2
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2016年第2期151-155,共5页
Journal of Clinical Anesthesiology
