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投稿时间：2020-05-16 网络发布日期：2021-04-20
投稿时间：2020-05-16 网络发布日期：2021-04-20
中文摘要: 目的 研究快速康复外科(ERAS)理念麻醉管理对小儿先天性心脏病(CHD)经胸介入手术治疗的作用及安全性。方法 回顾性选择2017年1月至2018年12月进行经胸介入手术治疗的CHD患儿80例作为研究对象,根据麻醉管理方式的不同,将患儿分为观察组与对照组。观察组患儿40例［房间隔缺损（房缺）11例，室间隔缺损（室缺）29例］,采用ERAS理念流程进行麻醉管理;对照组40例（房缺17例，室缺23例）,采用丙泊酚复合舒芬太尼静脉全麻方式。对比两组患儿各项恢复指标水平,围术期血流动力学,术后苏醒期气管导管的耐受及并发症发生率,生活质量。结果 观察组诱导至手术开始时间、术后气管导管留置时间、停留监护室时间、住院时间、医疗费用均显著低于对照组(P均<0.01),观察组心内操作时HR明显低于对照组(P<0.05),而平均动脉压（MAP）高于对照组(P<0.01)。观察组患儿术后苏醒期气管导管耐受率显著高于对照组(P<0.01),而并发症发生率明显低于对照组(P<0.05)。观察组术后生活质量评分显著高于对照组(P<0.05,P<0.01)。结论 对于CHD经胸介入治疗的患儿,采用ERAS理念流程进行麻醉,能够减少呼吸道并发症的发生率,使患儿的血流动力学指标趋于稳定,整体麻醉效果优于丙泊酚与舒芬太尼的复合麻醉,是一种安全有效的麻醉管理方式。
Abstract:Objective To explore the effect and safety of "enhanced recovery after surgery(ERAS)" anesthesia management on children with congenital heart disease(CHD) treated by transthoracic interventional surgery.
Methods Retrospective analysis was performed on 80 pediatric patients with CHD who underwent transthoracic interventional surgery from January 2017 to December 2018 as the research objects.According to different anesthesia management methods,the patients were divided into two groups:observation group and control group.Forty patients in observation group were anesthetized with the concept of ERAS.Forty cases in control group were given intravenous anesthesia combined with propofol and sufentanil.The levels of recovery indexes,perioperative hemodynamics,postoperative tolerance of endotracheal catheter,incidence of complications and quality of life were compared between the two groups.
Results The time from induction to the beginning of surgery,time of postoperative indwelling of endotracheal catheter,longth of ICU stay and hospital stay,and medical expenses in observation group were significantly lower than those in control group (all P<0.01).HR during intracardiac operation in observation group was significantly lower than that in control group (P<0.05),while MAP was higher than that in control group (P<0.01).In postoperative recovery period,the tolerance rate of endotracheal tube in observation group was significantly higher than that in control group (P<0.01),while the incidence of complications was significantly lower than that in control group (P<0.05).The postoperative quality of life score of observation group was significantly higher than that of control group (P<0.05,P<0.01).
Conclusions For the children with CHD treated by transthoracic interventional therapy,the ERAS concept of anesthesia management can reduce the the incidence of respiratory complications,stabilize the patient′s hemodynamic indexes,and the overall anesthetic effect is better than the combined anesthesia of propofol and sufentanil,so it is a safe and effective way of anesthetic management.
keywords: Congenital heart disease Transthoracic interventional therapy Enhanced recovery after surgery Anesthesia
文章编号： 中图分类号： 文献标志码：B
基金项目:广西壮族自治区玉林市科学研究与技术开发计划项目(20171609)
附件
| Author Name | Affiliation |
| HUANG Hai-lin,LIANG Yong-sheng,TANG Pei-jia,LIU Rui-jun | Department of Anesthesiology,the First People′s Hospital of Yulin,Yulin,Guangxi 537000,China |
引用文本：
黄海林,梁勇升,唐培佳,刘瑞军.快速康复外科理念麻醉管理在小儿先天性心脏病经胸介入手术治疗中的作用及安全性[J].中国临床研究,2021,34(4):482-485.
黄海林,梁勇升,唐培佳,刘瑞军.快速康复外科理念麻醉管理在小儿先天性心脏病经胸介入手术治疗中的作用及安全性[J].中国临床研究,2021,34(4):482-485.