本文關(guān)鍵詞：長托寧對(duì)小兒淺低溫體外循環(huán)下不停跳心內(nèi)直視術(shù)中微循環(huán)影響的探討　出處：《廣西醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 心臟不停跳心內(nèi)直視術(shù) 體外循環(huán) 小兒 微循環(huán) 鹽酸戊乙奎醚

【摘要】：目的：觀察鹽酸戊乙奎醚(Penehyclidine Hydrochloride, PHD),又稱長托寧,在小兒淺低溫體外循環(huán)下不停跳心內(nèi)直視術(shù)中對(duì)微循環(huán)功能的影響。 方法：擇期在淺低溫體外循環(huán)下行不停跳房間隔缺損(ASD)修補(bǔ)術(shù)或室間隔缺損(VSD)修補(bǔ)術(shù)的先天性心臟病患兒40例,根據(jù)住院號(hào)隨機(jī)分為長托寧組(P組)20例和對(duì)照組(C組)20例。兩組病例均予常規(guī)心臟手術(shù)麻醉及體外循環(huán)管理,P組在預(yù)充液中加入長托寧0.02mg/kg, C組予等量生理鹽水。兩組均為淺低溫不停跳心內(nèi)直視手術(shù),即均在維持心臟跳動(dòng)狀態(tài)完成手術(shù)。分別于麻醉誘導(dǎo)完成時(shí)(T0),中心溫度(肛溫)降溫至33℃時(shí)(T1),體外循環(huán)結(jié)束時(shí)(T2),手術(shù)結(jié)束時(shí)(T3),手術(shù)結(jié)束后1小時(shí)(T4)五個(gè)時(shí)間點(diǎn)抽取動(dòng)脈血檢測(cè)動(dòng)脈血乳酸值(Lac)。體外循環(huán)復(fù)溫時(shí)記錄鼻咽溫及肛溫復(fù)溫時(shí)間。體外循環(huán)全程記錄指脈氧飽和度(SpO2),心率(HR),尿量,平均動(dòng)脈壓(MAP)。 結(jié)果：(1)兩組患兒均完成實(shí)驗(yàn),無嚴(yán)重麻醉、手術(shù)及體外循環(huán)并發(fā)癥,無二次開胸,無術(shù)后死亡病例,40例患兒均順利出院。(2)兩組患兒的年齡、性別比、體重、病種、心功能分級(jí)、ASA分級(jí)、手術(shù)時(shí)間、體外循環(huán)時(shí)間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(3)兩組病例的Lac在體外循環(huán)開始前麻醉誘導(dǎo)完成時(shí)(T0)差異無統(tǒng)計(jì)學(xué)意義(P0.05)。在體外循環(huán)開始后各時(shí)間點(diǎn),相對(duì)于C組,P組Lac水平降低、Sp02提高、鼻咽溫及中心溫(肛溫)復(fù)溫時(shí)間縮短、尿量增加,心率無明顯變化,組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：淺低溫體外循環(huán)下心臟不停跳心內(nèi)直視術(shù)后會(huì)使術(shù)前循環(huán)及代謝正常的患兒造成微循環(huán)功能障礙。長托寧對(duì)小兒淺低溫體外循環(huán)下心臟不停跳心內(nèi)直視術(shù)中,對(duì)微循環(huán)功能有改善作用。
[Abstract]:Objective: to observe Penehyclidine Hydrochloride (PHD), also known as Changtonin, in Penehyclidine Hydrochloride Hydrochloride. Effect of cardiopulmonary bypass on the function of microcirculation during cardiopulmonary bypass in children. Methods: 40 children with congenital heart disease underwent ASD repair or VSD repair under mild hypothermia cardiopulmonary bypass. According to the hospital number, the patients were randomly divided into two groups: group P (n = 20) and group C (n = 20). The two groups were given routine cardiac surgery anesthesia and cardiopulmonary bypass (CPB). Group P added Changtonin 0.02 mg / kg to the prefilled solution, group C was given the same amount of normal saline. Both groups were treated with mild hypothermia and beating heart surgery. The operation was performed in the state of heart beating. The operation was performed at the time of anesthesia induction, when the central temperature (anal temperature) dropped to 33 鈩，

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