不同禁饮时间对先天性心脏病患儿麻醉诱导后液体反应性的影响
Effect of different clear fluid fasting duration on fluid responsiveness after anesthesia induction in pediatric patients with congenital heart disease
刘婷 1彭哲哲 1张马忠 1胡洁 1沈杨 1孙瑛1
作者信息
- 1. 上海交通大学医学院附属上海儿童医学中心麻醉科,上海 200127
- 折叠
摘要
目的 评价不同禁饮时间对先天性心脏病患儿麻醉诱导后液体反应性的影响.方法 选择上海交通大学医学院附属上海儿童医学中心2023年12月至2024年2月择期行房间隔缺损或室间隔缺损纠治术的先天性心脏病患儿100例,年龄6个月～3岁,BMI 13～19 kg/m2,ASA分级Ⅱ或Ⅲ级,性别不限.按患儿术前禁饮时间分为2组(n=50):长时间禁饮组(LF组),禁食和禁饮时间均≥6 h;短时间禁饮组(SF组),禁食时间≥6 h,术前2 h饮用术能多维营养液.分别于麻醉诱导前肝脏按压试验前即刻和肝脏按压试验后即刻、麻醉诱导后肝脏按压试验前即刻和肝脏按压试验后即刻,记录DBP,计算肝脏按压试验前后DBP的变化率(ΔDBP),以ΔDBP≥6.25％为液体反应性试验阳性.计算麻醉诱导前后液体反应性阳性率.结果 最终纳入64例患者,LF组32例,SF组32例.麻醉诱导前,LF组和SF组液体反应性阳性率分别为28.1％和18.8％,组间比较差异无统计学意义(P＞0.05).麻醉诱导后,LF组和SF组液体反应性阳性率分别为56.3％和28.0％,LF组高于SF组(P＜0.05).与麻醉诱导前比较,麻醉诱导后LF组液体反应性阳性率升高(P＜0.05),SF组液体反应性阳性率差异无统计学意义(P＞0.05).结论 长时间禁饮会导致先天性心脏病患儿麻醉诱导后液体反应性阳性率升高,呈现低容量状况.
Abstract
Objective To evaluate the effect of different clear fluid fasting duration on the fluid re-sponsiveness after anesthesia induction in pediatric patients with congenital heart disease.Methods One hundred pediatric patients with congenital heart disease who underwent elective atrial septal defect or ventricu-lar septal defect correction surgery at Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong Uni-versity School of Medicine from December 2023 to February 2024 were selected.They were of either sex,aged 6 months to 3 yr,with a body mass index of 13-19 kg/m2,and classified as American Society of Anesthesiolo-gists Physical Status classification Ⅱ or Ⅲ.Patients who adhered to the prescribed preoperative clear fluid fast-ing regimen,with a fasting duration of 6 h or longer before surgery,were included in the long fasting(LF)group,while those who were prescribed multi-dimensional nutritional solution until 2 h before surgery with a solid fasting duration ≥6 h were considered for inclusion in the short fasting(SF)group.The diastolic blood pressure(DBP)was recorded immediately before and after liver compression test at pre-induction of anesthe-sia and immediately before and after liver compression test at post-induction of anesthesia,and the changes in DBP before and after the liver compression test(ΔDBP)were calculated.Positive fluid responsiveness was defined as an increase in ΔDBP≥6.25％.The positive rate of fluid responsiveness before and after anesthesia induction was calculated.Results Sixty-four patients were finally included,and both LF and SF groups in-cluded 32 cases.Before the induction of anesthesia,the positive rate of fluid responsiveness induced by liver compression was 28.1％in LF group and 18.8％in SF group,and the difference was not statistically significant(P＞0.05).However,after the induction of anesthesia,the positive rate of fluid responsiveness induced by liv-er compression was 56.3％in LF group and 28.0％in SF group,with a statistically significant difference ob-served(P＜0.05).Compared with the baseline before anesthesia induction,the positive rate of fluid respon-siveness was significantly increased in LF group(P＜0.05),and no significant change was found in the posi-tive rate of fluid responsiveness in SF group(P＞0.05).Conclusions The prolonged clear fluid fasting may lead to an increase in the positive rate of fluid responsiveness following anesthesia induction in pediatric pa-tients with congenital heart disease,presenting as a state of hypovolemia.
关键词
禁食/心脏缺损,先天性/婴儿/血管容量Key words
Fasting/Heart defects,congenital/Infant/Vascular capacitance引用本文复制引用
基金项目
上海市浦东新区科技发展基金(PKJ2020-Y07)
出版年
2024
NETL
NSTL
万方数据