快通道麻醉在小儿先天性心脏病手术中的应用及对镇静、镇痛效果的影响
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摘要
目的:探讨快通道麻醉在小儿先天性心脏病手术中的应用及对镇静、镇痛效果的影响。方法:选择2016年6月至2018年5月在桂林医学院附属医院进行手术治疗的小儿先天性心脏病患儿82例,按照随机数字表法分为对照组(41例)和观察组(41例),对照组进行常规麻醉,观察组则采用快通道麻醉。对比两组患儿麻醉药物用量、手术时间、阻断时间、体外循环时间、术后拔管时间、住院时间、住院费用及并发症发生情况,观察两组患儿术后12h镇静、镇痛效果。结果:观察组患儿芬太尼和罗库溴铵用量明显低于对照组(P<0.05)。两组患儿的术中各指标比较无统计学差异(P>0.05),而与对照组相比,观察组患儿术后住院时间、拔管时间均缩短,且住院费用减少(P<0.05)。观察组患儿术后12h的镇静及镇痛效果均优于对照组(P<0.05)。观察组患儿术后并发症发生率为17.07%(7/41),低于对照组的39.02%(16/41)(P<0.05)。结论:快通道麻醉可减少小儿先天性心脏病手术的芬太尼和罗库溴铵用量,不仅缩短术后拔管时间和住院时间,降低住院费用,而且可改善镇静及镇痛效果,安全有效。
Objective: To investigate the application of fast track anesthesia in pediatric congenital heart disease and its effects on sedation and analgesia. Methods: 82 children with congenital heart disease who underwent surgical treatment in Affiliated Hospital of Guilin Medical College from June 2016 to May 2018 were selected. They were divided into control group(41 cases) and observation group(41 cases) according to the random number table method. The control group received routine anesthesia, while the observation group received fast track anesthesia. The dosage of anesthetic drugs, operative time, interruption time, cardiopulmonary bypass time,postoperative extubation time, hospitalization time, hospitalization expenses and complications were compared between the two groups.The sedation, analgesic effect at 12 h after operation of the two groups were observed. Results: The dosage of fentanyl and rocuronium in the observation group was significantly lower than that in the control group(P <0.05). There was no significant difference in intraoperative indexes between the two groups(P>0.05). Compared with the control group, the hospitalization time and extubation time of the observation group were shortened, and the hospitalization expenses were reduced(P<0.05). The sedative and analgesic effects at12 h after operation in the observation group were better than that in the control group(P <0.05). The incidence of postoperative complications in the observation group was 17.07%(7/41), which was lower than 39.02%(16/41) in the control group(P <0.05).Conclusion: Fast track anesthesia can reduce the dosage of fentanyl and rocuronium in pediatric congenital heart disease. It not only shortens postoperative extubation time and hospitalization time, reduces hospitalization expenses, but also improves sedative and analgesic effects, and it is safe and effective.
Objective: To investigate the application of fast track anesthesia in pediatric congenital heart disease and its effects on sedation and analgesia. Methods: 82 children with congenital heart disease who underwent surgical treatment in Affiliated Hospital of Guilin Medical College from June 2016 to May 2018 were selected. They were divided into control group(41 cases) and observation group(41 cases) according to the random number table method. The control group received routine anesthesia, while the observation group received fast track anesthesia. The dosage of anesthetic drugs, operative time, interruption time, cardiopulmonary bypass time,postoperative extubation time, hospitalization time, hospitalization expenses and complications were compared between the two groups.The sedation, analgesic effect at 12 h after operation of the two groups were observed. Results: The dosage of fentanyl and rocuronium in the observation group was significantly lower than that in the control group(P <0.05). There was no significant difference in intraoperative indexes between the two groups(P>0.05). Compared with the control group, the hospitalization time and extubation time of the observation group were shortened, and the hospitalization expenses were reduced(P<0.05). The sedative and analgesic effects at12 h after operation in the observation group were better than that in the control group(P <0.05). The incidence of postoperative complications in the observation group was 17.07%(7/41), which was lower than 39.02%(16/41) in the control group(P <0.05).Conclusion: Fast track anesthesia can reduce the dosage of fentanyl and rocuronium in pediatric congenital heart disease. It not only shortens postoperative extubation time and hospitalization time, reduces hospitalization expenses, but also improves sedative and analgesic effects, and it is safe and effective.
引文
[1] Mari MA, Cascudo MM, Alchieri JC, et al. Congenital Heart Disease and Impacts on Child Development[J]. Braz J Cardiovasc Surg, 2016,31(1):31-37
[2] Amedro P, Gavotto A, Guillaumont S, et al. Cardiopulmonary fitness in children with congenital heart diseases versus healthy children[J].Heart, 2018, 104(12):1026-1036
[3] Judge P, Meckler Mshs G. Congenital Heart Disease In Pediatric Patients:Recognizing The Undiagnosed And Managing Complications In The Emergency Department[J]. Pediatr Emerg Med Pract, 2016, 13(5):1-28
[4] Schwartz LI, Twite M, Gulack B, et al. The Perioperative Use of Dexmedetomidine in Pediatric Patients with Congenital Heart Disease:An Analysis from the Congenital Cardiac Anesthesia Society-Society of Thoracic Surgeons Congenital Heart Disease Database[J]. Anesth Analg, 2016, 123(3):715-721
[5] Nasr VG, Guzzetta NA, Miller-Hance WC, et al. Consensus Statement by the Congenital Cardiac Anesthesia Society:Milestones for the Pediatric Cardiac Anesthesia Fellowship[J]. Anesth Analg, 2018, 126(1):198-207
[6] Yamamoto T, Schindler E. Anaesthesia management for non-cardiac surgery in children with congenital heart disease[J]. Anaesthesiol Intensive Ther, 2016, 48(5):305-313
[7]莫伟波,黎必万,檀文好,等.快通道麻醉对行手术治疗先天性心脏病患儿心肌氧化应激损伤及血清miR-1的影响[J].中华实用诊断与治疗杂志, 2017, 31(11):1118-1121
[8] Zayat R, Menon AK, Goetzenich A, et al. Benefits of ultra-fast-track anesthesia in left ventricular assist device implantation:a retrospective, propensity score matched cohort study of a four-year single center experience[J]. J Cardiothorac Surg, 2017, 12(1):10
[9]莫伟波,黎必万,檀文好,等.快通道麻醉对先天性心脏病手术患儿外周血炎症因子及微小核糖核酸-1的影响[J].广西医科大学学报,2018, 35(1):26-29
[10]王薇,石双平,胡柳生,等.小儿先天性心脏病快通道麻醉中Narcotrend脑电监测的应用价值[J].现代中西医结合杂志, 2015,(20):2250-2251, 2252
[11] Akhtar MI, Hamid M, Minai F, et al. Safety profile of fast-track extubation in pediatric congenital heart disease surgery patients in a tertiary care hospital of a developing country:An observational prospective study[J]. J Anaesthesiol Clin Pharmacol, 2014, 30(3):355-359
[12] Harris KC, Holowachuk S, Pitfield S, et al. Should early extubation be the goal for children after congenital cardiac surgery?[J]. J Thorac Cardiovasc Surg, 2014, 148(6):2642-2647
[13]卢建军,庞辉,廖南益.先天性心脏病与ABO血型的关系[J].中国病案, 2011, 12(5):67
[14]李渭敏,仲吉英,徐枫,等.骶管内注射右美托咪定用于小儿心脏手术快通道麻醉的效果观察[J].广东医学, 2018, 39(4):624-627
[15] Varrica A, Lo Rito M, Generali T, et al. Surgical rescue after transcatheter interventional procedures in congenital heart disease patients:an existing problem[J]. EuroIntervention, 2017, 12(14):1724-1729
[16]陈刚,李红霞,张晓晓,等.高压氧与术前前列地尔联合治疗先天性心脏病伴重度肺动脉高压的临床效果分析[J].现代生物医学进展,2016, 16(33):6549-6552
[17] Junghare SW, Desurkar V. Congenital heart diseases and anaesthesia[J]. Indian J Anaesth, 2017, 61(9):744-752
[18] Twite M, Ing RJ. Noteworthy Literature in 2015:Anesthesia for Congenital Heart Disease[J]. Semin Cardiothorac Vasc Anesth, 2016,20(1):14-23
[19]雷迁,曾庆诗,钟执文,等.超快通道麻醉在胸腔镜体外循环心脏手术中的应用[J].岭南心血管病杂志, 2016, 22(2):170-173
[20] Silva PS, Cartacho MP, Castro CC, et al. Evaluation of the influence of pulmonary hypertension in ultra-fast-track anesthesia technique in adult patients undergoing cardiac surgery[J]. Rev Bras Cir Cardiovasc, 2015, 30(4):449-458
[21] Guzzetta NA, Zabala L, Mossad EB. The Congenital Cardiac Anesthesia Society:An Update on the First Twelve Years[J]. J Cardiothorac Vasc Anesth, 2017, 31(6):1939-1942
[22]张全意,丁洁,罗启鹏,等.超快通道麻醉对小儿心脏手术后C反应蛋白和降钙素原的影响[J].中国循环杂志, 2016, 31(2):161-164
[23] Villafranca A, Thomson IA, Grocott HP, et al. The impact of bispectral index versus end-tidal anesthetic concentration-guided anesthesia on time to tracheal extubation in fast-track cardiac surgery[J]. Anesth Analg, 2013, 116(3):541-548
[24] Hemmerling TM. Immediate extubation after cardiac surgery should be part of routine anesthesia practice for selected patients[J].Ann Card Anaesth, 2018, 21(2):114-115
[25] Hasija S, Chauhan S, Jain P, et al. Comparison of speed of inhalational induction in children with and without congenital heart disease[J]. Ann Card Anaesth, 2016, 19(3):468-474
[26] Ramos Ramos V, Mesa Suárez P, Santotoribio JD, et al.Neuroprotective effect of sevoflurane in general anaesthesia[J]. Med Clin(Barc), 2017, 148(4):158-160
[27]黎必万,陈贤.快通道麻醉在小儿先天性心脏病手术中的应用[J].疑难病杂志, 2014, 13(3):322-326
[28] He J, Zhang Y, Xue R, et al. Effect of Desflurane versus Sevoflurane in Pediatric Anesthesia:A Meta-Analysis[J]. J Pharm Pharm Sci,2015, 18(2):199-206
[29]吴树宁.快通道麻醉在儿科手术中的临床应用[J].实用临床医药杂志, 2013, 17(9):130-132
[30] Bainbridge D, Cheng DC. Early extubation and fast-track management of off-pump cardiac patients in the intensive care unit[J].Semin Cardiothorac Vasc Anesth, 2015, 19(2):163-168
[2] Amedro P, Gavotto A, Guillaumont S, et al. Cardiopulmonary fitness in children with congenital heart diseases versus healthy children[J].Heart, 2018, 104(12):1026-1036
[3] Judge P, Meckler Mshs G. Congenital Heart Disease In Pediatric Patients:Recognizing The Undiagnosed And Managing Complications In The Emergency Department[J]. Pediatr Emerg Med Pract, 2016, 13(5):1-28
[4] Schwartz LI, Twite M, Gulack B, et al. The Perioperative Use of Dexmedetomidine in Pediatric Patients with Congenital Heart Disease:An Analysis from the Congenital Cardiac Anesthesia Society-Society of Thoracic Surgeons Congenital Heart Disease Database[J]. Anesth Analg, 2016, 123(3):715-721
[5] Nasr VG, Guzzetta NA, Miller-Hance WC, et al. Consensus Statement by the Congenital Cardiac Anesthesia Society:Milestones for the Pediatric Cardiac Anesthesia Fellowship[J]. Anesth Analg, 2018, 126(1):198-207
[6] Yamamoto T, Schindler E. Anaesthesia management for non-cardiac surgery in children with congenital heart disease[J]. Anaesthesiol Intensive Ther, 2016, 48(5):305-313
[7]莫伟波,黎必万,檀文好,等.快通道麻醉对行手术治疗先天性心脏病患儿心肌氧化应激损伤及血清miR-1的影响[J].中华实用诊断与治疗杂志, 2017, 31(11):1118-1121
[8] Zayat R, Menon AK, Goetzenich A, et al. Benefits of ultra-fast-track anesthesia in left ventricular assist device implantation:a retrospective, propensity score matched cohort study of a four-year single center experience[J]. J Cardiothorac Surg, 2017, 12(1):10
[9]莫伟波,黎必万,檀文好,等.快通道麻醉对先天性心脏病手术患儿外周血炎症因子及微小核糖核酸-1的影响[J].广西医科大学学报,2018, 35(1):26-29
[10]王薇,石双平,胡柳生,等.小儿先天性心脏病快通道麻醉中Narcotrend脑电监测的应用价值[J].现代中西医结合杂志, 2015,(20):2250-2251, 2252
[11] Akhtar MI, Hamid M, Minai F, et al. Safety profile of fast-track extubation in pediatric congenital heart disease surgery patients in a tertiary care hospital of a developing country:An observational prospective study[J]. J Anaesthesiol Clin Pharmacol, 2014, 30(3):355-359
[12] Harris KC, Holowachuk S, Pitfield S, et al. Should early extubation be the goal for children after congenital cardiac surgery?[J]. J Thorac Cardiovasc Surg, 2014, 148(6):2642-2647
[13]卢建军,庞辉,廖南益.先天性心脏病与ABO血型的关系[J].中国病案, 2011, 12(5):67
[14]李渭敏,仲吉英,徐枫,等.骶管内注射右美托咪定用于小儿心脏手术快通道麻醉的效果观察[J].广东医学, 2018, 39(4):624-627
[15] Varrica A, Lo Rito M, Generali T, et al. Surgical rescue after transcatheter interventional procedures in congenital heart disease patients:an existing problem[J]. EuroIntervention, 2017, 12(14):1724-1729
[16]陈刚,李红霞,张晓晓,等.高压氧与术前前列地尔联合治疗先天性心脏病伴重度肺动脉高压的临床效果分析[J].现代生物医学进展,2016, 16(33):6549-6552
[17] Junghare SW, Desurkar V. Congenital heart diseases and anaesthesia[J]. Indian J Anaesth, 2017, 61(9):744-752
[18] Twite M, Ing RJ. Noteworthy Literature in 2015:Anesthesia for Congenital Heart Disease[J]. Semin Cardiothorac Vasc Anesth, 2016,20(1):14-23
[19]雷迁,曾庆诗,钟执文,等.超快通道麻醉在胸腔镜体外循环心脏手术中的应用[J].岭南心血管病杂志, 2016, 22(2):170-173
[20] Silva PS, Cartacho MP, Castro CC, et al. Evaluation of the influence of pulmonary hypertension in ultra-fast-track anesthesia technique in adult patients undergoing cardiac surgery[J]. Rev Bras Cir Cardiovasc, 2015, 30(4):449-458
[21] Guzzetta NA, Zabala L, Mossad EB. The Congenital Cardiac Anesthesia Society:An Update on the First Twelve Years[J]. J Cardiothorac Vasc Anesth, 2017, 31(6):1939-1942
[22]张全意,丁洁,罗启鹏,等.超快通道麻醉对小儿心脏手术后C反应蛋白和降钙素原的影响[J].中国循环杂志, 2016, 31(2):161-164
[23] Villafranca A, Thomson IA, Grocott HP, et al. The impact of bispectral index versus end-tidal anesthetic concentration-guided anesthesia on time to tracheal extubation in fast-track cardiac surgery[J]. Anesth Analg, 2013, 116(3):541-548
[24] Hemmerling TM. Immediate extubation after cardiac surgery should be part of routine anesthesia practice for selected patients[J].Ann Card Anaesth, 2018, 21(2):114-115
[25] Hasija S, Chauhan S, Jain P, et al. Comparison of speed of inhalational induction in children with and without congenital heart disease[J]. Ann Card Anaesth, 2016, 19(3):468-474
[26] Ramos Ramos V, Mesa Suárez P, Santotoribio JD, et al.Neuroprotective effect of sevoflurane in general anaesthesia[J]. Med Clin(Barc), 2017, 148(4):158-160
[27]黎必万,陈贤.快通道麻醉在小儿先天性心脏病手术中的应用[J].疑难病杂志, 2014, 13(3):322-326
[28] He J, Zhang Y, Xue R, et al. Effect of Desflurane versus Sevoflurane in Pediatric Anesthesia:A Meta-Analysis[J]. J Pharm Pharm Sci,2015, 18(2):199-206
[29]吴树宁.快通道麻醉在儿科手术中的临床应用[J].实用临床医药杂志, 2013, 17(9):130-132
[30] Bainbridge D, Cheng DC. Early extubation and fast-track management of off-pump cardiac patients in the intensive care unit[J].Semin Cardiothorac Vasc Anesth, 2015, 19(2):163-168