儿童先天性心脏病介入治疗术中不良事件与麻醉管理分析

Analysis of intraoperative adverse events and the anesthestic management during interventional therapy in children with congenital heart diseases

摘要:

目的：从围术期麻醉管理角度分析儿童先天性心脏病介入治疗术中不良事件和麻醉管理安全性关系，试图提出相应的预防措施和建议。方法：回顾性分析不同麻醉方法（静脉全麻、喉罩静吸复合全麻和气管插管全麻）下1 792例介入治疗术中出现不良事件的类型、发生率、死亡原因及处理等。对可以预知的麻醉高危因素加以强化管理，降低麻醉相关不良事件。结果：麻醉相关因素引起的不良事件发生率为3.63%（65/1792），经及时处理后好转，不影响患儿预后。手术相关不良事件发生率为2.40%（43/1792），其中死亡4例，总死亡率为0.22%。3种麻醉方法中静脉全麻组不良事件发生率最高（12.6%，P=0.000），且危险性高。结论：术前根据患儿不同的病情和生理状况，选择合适的麻醉管理方案，对可以预知的高危因素加以强化，制定合理的应急处理方案。有效的围术期监测及科室团结协作可以降低先心病介入治疗术中不良事件的发生率。

Abstract:

Objective：To investigate the correlation between intraoperative complications during interventional therapy in children with congenital heart diseases and anesthesia management safety and to put forward corresponding preventive measures. Methods：A retro－spective analysis was made on type，incidence，cause and treatment of adverse events after undergoing different anesthesia treatments （intravenous anesthesia，laryngeal mask combined with intravenous inhalation anesthesia and tracheal intubation） in 1 792 cases of interventional therapy. Results：Incidence of adverse event related with anesthesia was 3.63%（65/1 792）. After timely treatment，all recovered well. Incidence of adverse event related with operation was 2.40%（43/1 792），including 4 death cases died with mortality of 0.22%（4/1792）. The intravenous anesthesia group had the highest incidence of adverse events（12.6%，P=0.000）. Conclusion：Choosing appropriate anesthesia methods based on patients’ different physical condition can strengthen management of high risk fac－tors and formulate appropriate urgent treatment plan. Effective peri-operative monitoring and effective cooperation can reduce the in－cidence of serious complications in children’s congenital heart disease intervention.