在接受心脏手术的婴儿中,在全身麻醉下高脊髓麻醉的血液动力学影响:一项回顾性队列研究
Aravinthasamy Sivamurugan1, Rakesh Sondekoppam2, Sudhakar Subramani3
1Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Journal of thoracic disease
|August 14, 2025
概括
高脊髓麻醉 (HSA) 与全身麻醉 (GA) 结合,对于接受心脏手术的婴儿是安全的. 血动力学稳定性在HSA和GA组之间是相似的,在低血压或心肌压力方面没有显著差异.
科学领域:
- 麻醉学 麻醉学
- 儿童心脏病学 儿童心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 高脊髓麻醉 (HSA) 结合全身麻醉 (GA) 在心脏手术中被探索,以减少手术压力和阿片类药物的使用.
- 有关HSA在患有先天性心脏病的婴儿中造成血液动力学不稳定的潜力存在担忧.
研究的目的:
- 评估HSA对接受心脏手术的婴儿血液动力学参数的影响.
- 评估HSA与GA在儿科心脏手术中的安全性.
主要方法:
- 对202名接受非紧急心脏手术的婴儿 (1-12个月) 进行了回顾性队列研究.
- 对接受HSA + GA与单独接受GA的患者进行比较,不包括高风险患者 (RACHS-1 > 3).
- 主要结局:诱导后60分钟内持续低血压和胸的发生率;次要结局:压力器的使用,平均MAP和HR.
主要成果:
- 在HSA和GA组之间,持续的低血压 (39.2%vs. 40.4%) 或心肌梗塞 (11.8%vs. 6.6%) 没有显著差异.
- 在手术期间使用压力器的情况也相似 (9.8%对11.9%).
- 在HSA组中较低的平均,最小和最大心率在临床上没有显著意义.
结论:
- 在接受非急性快速心脏手术的婴儿中,将HSA与GA结合在一起,在血液动力学稳定性方面与GA单独使用一样安全.
- 平均动脉压和心率在两组中都保持在可接受的临床限度内.
相关概念视频
General Anesthesia: Overview
283
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
283
Local Anesthetics: Clinical Application as Spinal Anesthesia
778
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
778
Local Anesthetics: Clinical Application as Epidural Anesthesia
498
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
498
Parenteral Anesthetics: Overview
198
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
198
Stages of General Anesthesia
698
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
698
Cardiomyopathy VII: Pre and Post Operative Nursing Management
27
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
27


