右美托咪啶与丙泊酚用于小儿心导管术麻醉维持的比较

Comparison of dexmedetomidine with propofol for maintenance of anesthesia undergoing cardiac catheterization in children

目的 右美托咪啶（dexmedetomidine，DEX）为饯：肾上腺素受体激动剂，目前较多研究正在探索其用于／DJL麻醉的可行性。研究比较了DEX与丙泊酚用于小儿心导管术的维持麻醉的药效学。方法 选择40例ASA Ⅱ-Ⅲ级、22月-67月、体重11kg-28kg导管介入治疗患儿，进入导管室后静注氯胺酮2mg／kg，咪达唑仑0．1mg／kg，长托宁0．05mg／kg。按抽签的方法随机分为2组（每组20例）：D组10min内静脉输注负荷量DEXO．8μg／kg，随后以lμg·kg^-1.h^-1连续输注；P组10min内静脉输注负荷量丙泊酚1．5mg／kg，随后以3mg·kg^-1.h^-1。连续输注。术中根据调节DEX或丙泊酚输注速度，维持脑电双频指数值在55-65。麻醉前、麻醉后10min和40min记录循环、呼吸指标并观察回病房后镇静药需求。结果麻醉后40min，D组心率（HR）（117±10）次／分显著低于P组（126±9）次／分（P〈O．05）；麻醉后两组呼气末二氧化碳分压（end-tida pressure of carbon dioxide，PetCO2）均较基础值轻微升高，但差异无统计学意义（P〉O．05）。P组需镇静治疗的患儿（12例）显著多于D组（P〈O．05）。结论 DEX和丙泊酚均可为小儿心导管介入提供充分的麻醉。相比丙泊酚，患儿HR减慢，但术后躁动较少。

Objective Dexmedetomidine（DEX） is a2 agonist currently being investigated for its application in anesthesia for children. Pharmacodynamic responses to DEX and propofol in children anesthetized undergoing cardiac catheterization were compared. Methods Forty children（ 22 kg-67 kg months old, 11 kg-28 kg） were randomized to receive either propofol （group P） or DEX（group D） for anesthesia maintenance for elective cardiac catheterization. All patients received ketamine 2 mg/kg, midazolam 0.1 mg/kg and penehyclidine hydrochloride 0.05 mg/kg intravenously after arriving at the cardiac catheterization room. DEX was administered at an initial loading dose （0.8 g/kg for 10 rain） followed by a continuous infusion （1μg.kg^-l.h^-l） in group D. Propofol was administered at a bolus dose （1.5 mg.kg4.h^-1 for 10 min） followed by a continuous infusion（3 mg＇kg^-1.h^-1）. The infusion rates of DEX or propofol were adjusted to maintain BIS 55 to 65 during the operation. Vital signs, PerCO2 and supplemental sedatives were monitored and documented. Results Heart rate was significantly slower in group D （117±10） bpm than in group P （126±9） bpm 40 min after DEX or propofol administration （P〈O.05）. There was no significant difference in P^CO2 between two groups. Requirement of supplemental sedatives was less in group D than in group P （12 cases）（P〈0.05）. Conclusion DEX provides adequate anesthesia for cardiac catheterization. Compared with propofol, DEX led to lower heart rate and less agitation alter catheterization.