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目的:探讨复杂先心病患儿作诊断性检查的麻醉处理。方法:34例作心导管检查或心血管造影的复杂先心病患儿,入导管室后肌注氯胺酮作基础麻醉并开通外周静脉,其中6例静注氯胺酮、安定、维库溴铵等药后作气管插管全麻,另28例非插管全麻患儿以氯胺酮、安定维持麻醉。紫绀明显的患儿给予碳酸氢钠。所有患儿均监测SPO2、ECG、HR,导管检查过程中还观察患儿动脉压和肺动脉压。结果:术中有5例患儿SPO2下降明显,2例出现心律失常,经对症处理后好转。全部患儿均完成检查,术后无麻醉并发症。结论:在导管室为此类作诊断性检查的患儿麻醉,应做好麻醉前准备,导管室内配置一定的监测、抢救设备及麻醉用药和各种抢救用药。麻醉人员必须熟悉各类复杂先心病的病理生理,术中出现异常情况应和术者沟通,及时处理,才能保障患儿安全、顺利地进行检查。
Objective: To investigate the diagnosis of complicated congenital heart disease in children with anesthesia. Methods: Thirty-four children with complicated congenital heart disease who underwent cardiac catheterization or cardiovascular angiography were injected intramuscularly with ketamine for catheter anesthesia and peripheral vein was opened. Among them, 6 patients received intravenous ketamine, diazepam and vecuronium General anesthesia for tracheal intubation, and the other 28 cases of non-cannulated general anesthesia with ketamine, stability and stability of anesthesia. Children with cyanosis were given sodium bicarbonate. All children were monitored SPO2, ECG, HR, arterial pressure and pulmonary artery pressure were also observed during catheterization. Results: There were 5 cases of intraoperative SPO2 decreased significantly, 2 cases of arrhythmia, improved after symptomatic treatment. All children were completed examination, no postoperative complications of anesthesia. CONCLUSIONS: Anesthesia should be done in this area for such diagnostic tests in the catheterization room. Pre-anesthesia preparation, catheterization, monitoring, rescue equipment, narcotic medication and various rescue medications should be performed. Anesthesia staff must be familiar with the pathophysiology of various complex congenital heart disease, abnormalities during surgery should communicate with the surgeon, timely treatment, in order to protect children safe and smooth examination.