Spinal Anesthesia with an Indwelling Catheter Reduces the Stress Response in Pediatric Open Heart Surgery
Spinal Anesthesia with an Indwelling Catheter Reduces the Stress Response in Pediatric Open Heart Surgery
复制标题
留置导管脊髓麻醉可减少小儿心脏直视手术中的应激反应
作者：
N. Humphreys;S. Bays;A. Parry;A. Pawade;R. Heyderman;A. Wolf
背景：心脏直视手术的极端应激和炎症反应与发病率和死亡率增加相关。根据动物和成人数据，假设对于接受心脏直视手术的婴儿和幼儿来说，脊髓麻醉比传统的高剂量静脉注射阿片类药物技术更能有效地减弱这些反应。方法：对 60 名 24 个月以下接受心脏直视手术的儿童进行了一项前瞻性随机对照临床试验。患者被随机分配接受高剂量静脉阿片类药物或高剂量静脉阿片类药物加脊髓麻醉。通过留置鞘内导管进行脊髓麻醉。结果：根据血浆去甲肾上腺素和肾上腺素浓度测量，脊髓麻醉显着降低了应激反应（均 P < 0.05）。脊髓麻醉降低了血浆乳酸浓度（P < 0.05），但术后第一天的液体需求量增加（P < 0.05）。其他心血管参数没有差异。结论：连续脊髓麻醉比单独大剂量静脉注射阿片类药物更能有效地减少接受体外循环心脏手术的婴幼儿的应激反应。
Background:Extreme stress and inflammatory responses to open heart surgery are associated with increased morbidity and mortality. Based on both animal and adult human data, it was hypothesized that spinal anesthesia would be more effective at attenuating these responses than conventional high dose intravenous opioid techniques in infants and young children undergoing open heart surgery. Methods:A prospective randomized controlled clinical trial was performed in 60 children aged up to 24 months undergoing open heart surgery. Patients were randomly assigned to receive either high-dose intravenous opioid or high-dose intravenous opioid plus spinal anesthesia. Spinal anesthesia was administered via an indwelling intrathecal catheter. Results:Spinal anesthesia significantly reduced the stress responses as measured by plasma norepinephrine and epinephrine concentrations (both P < 0.05). Spinal anesthesia reduced plasma lactate concentrations (P < 0.05), but increased fluid requirements during the first postoperative day (P < 0.05). There were no differences in other cardiovascular parameters. Conclusions:Continuous spinal anesthesia reduces stress responses in infants and young children undergoing cardiac surgery with cardiopulmonary bypass more effectively than high-dose intravenous opioids alone.
羔羊胎儿心脏搭桥术的长期幸存者。
DOI：
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发表时间：
1994
期刊：
The Journal of thoracic and cardiovascular surgery
影响因子：
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作者：
Fenton,KN;Zinn,HE;Heinemann,MK;Liddicoat,JR;Hanley,FL
通讯作者：
Hanley,FL