盐酸右美托咪定用于小儿心脏术后患者镇静的临床观察

The clinical effect of dexmedetomidine in pediatric patients after cardiac surgery

目的探讨盐酸右美托咪定对于ICU中小儿心脏术后患者的镇静效果和安全性。方法纳入11例需机械通气的小儿心脏术后患者,给予负荷剂量0.5μg/kg静脉注射,时间大于10 min,维持剂量为0.2~0.5μg/kg/h,记录用药前（T0）和用药后0.25 h（T1）、1h（T2）、2 h（T3）和4 h（T4）5个点的Ramsay镇静评分、心率、收缩压、舒张压、中心静脉压、自主呼吸和血氧饱和度等指标,观察药物的效果及不良反应。镇静4 h时停用药物,记录神志恢复时间。结果 T1-4点的Ramsay镇静评分显著高于T0点（P〈0.05）,T1-4点的心率、收缩压和舒张压显著低于T0点（P〈0.05）,T1-4点的中心静脉压和血氧饱和度较T0点差异无统计学意义（P〉0.05）,对自主呼吸无抑制作用（P〈0.05）,1例患儿因低血压用药2 h后停药,耐受率90.1%。结论盐酸右美托咪定对于小儿心脏术后监护患者镇静效果良好,虽可降低患儿心率、血压,但未出现严重不良反应,用药时注意维持血容量稳定和密切监护。

Objective To explore the sedative effects and safety of dexmedetomidine on pediatric patients after cardiac surgery in intensive care unit.Methods The research team included 11 pediatric patients post cardiac surgery.The drug was given by two steps： first injection at 0.5 ug/kg for 10 min,and then maintained at 0.2~0.5 μg/kg/h.The Ramsay sedation score was recorded,HR,SBP,DBP,RR,CVP and SPO2 before injection（T0） and 0.25 h（T1）,1 h（T2）,2 h（T3）,4 h（T4） after infusion.The effects of drugs and adverse reactions were observed.The medications were ceased after 4h,then the sedative degree was assessed and record the recover time.Results The Ramsay sedation scores at T1-4 were significantly decreased compared with those of at T0（P0.05）.The HR,SBP and DBP at T1-4 were significantly decreased compared with those of at T0（P0.05）.The CVP and SPO2 were no significant difference between T0 and T1-4（P0.05）.There were no depression on spontaneous breathing（P0.05）.Because of low blood pressure,one patient stopped medication at T3,90.1% of patients could complete treatment program.Conclusion The pediatric patients after cardiac surgery in intensive care unit could achieve satisfactory sedation by using dexmedetomidine.The HR,SBP and DBP were decreased significantly during medication.There were no serious adverse reactions.Maintain stable blood volume and close monitoring are very important.