右美托咪定在先天性心脏病术后患儿镇静中的临床应用

Clinical use of dexmedetomidine for post-operative children with congenital heart disease

目的:观察α2-肾上腺素受体激动剂右美托咪定(Dex)对先天性心脏病(CHD)术后患儿的镇静效果及安全性。方法:选择先天性心脏病术后带气管插管入ICU行呼吸机辅助通气患儿40例,按随机数字表法分为两组,分别给予咪达唑仑(对照组,20例)和右美托咪定(DEX组,20例)镇静治疗,两组均常规给予舒芬太尼持续静脉泵入镇痛,根据Prince-Henry镇痛评分调整舒芬太尼剂量,使疼痛评分维持在1～2分;根据Ramsay评分调整镇静药剂量,使镇静深度评分控制在3～4分;连续监测记录呼吸、心率、血压、脉搏血氧饱和度,并进行血气分析。观察记录两组药物用量,机械通气(MV)时间,以及恶心、呕吐、腹胀、心律失常、神经系统异常、癫痫、撤药反应等副作用发生率。结果:两组均能使患儿达到镇静及镇痛目标评分,DEX组更易唤醒并保持安静。与对照组比较,DEX组舒芬太尼用量明显减少[(0.38±0.12)μg/(kg.h)与(0.56±0.16)μg/(kg.h)],差异有统计学意义(P<0.01);两组间平均动脉压(MAP)、心率(HR)在不同时间点比较,差异无统计学意义(P>0.05);两组间指尖血氧饱和度(SpO2)及血气分析(包括pH值、PaO2、PaCO2)差异无统计学意义(P>0.05)。MV时间、ICU停留时间、住院时间及死亡率两组间比较,差异无统计学意义(P>0.05)。结论:DEX用于CHD术后MV患儿镇静效果满意,可减少舒芬太尼用量,血流动力学稳定,对呼吸抑制小,用药过程中及用药停止后呼吸无明显变化,是一种较为理想的C1CU镇静剂。

Objective To observe the effect of ot 2-adrenergic receptor agonist dexmedetomidine（Dex） in children with congenital heart disease（CHD） in children with sedative effect and safety of postoperative.Methods After surgery for congenital heart disease with endotracheal intubation mechanical ventilation in ICU patients 40 cases,were randomly divided into two groups,were given midazolam（control group,20 cases） and dexmedetomidine（group DEX 20 cases,sedative treatment）,the two groups were treated with conventional administration of sufentanil intravenous analgesia, according to Prince-Henry analgesia sufentanil dose adjustment,the pain scores at 1 - 2;according to Ramsay score adjustment sedative dose,the depth of sedation score control in 3 ~ 4;continuous monitoring and recording of respiratory, heart rate,blood pressure,pulse oxygen saturation,and blood gas analysis.Observed two groups of drug dosage,time of mechanical ventilation（MV）,as well as nausea,vomiting,abdominal distension,arrhythmia,nervous system disorders,epilepsy, drug withdrawal reaction rate of side effects.Results The two groups were able to make the children reach the target score of sedation and analgesia,DEX group are more likely to wake up and keep quiet.Compared with the control group,DEX group sufentanil significantly reduced the amount of [（0.38 ~ 0.12） and （0.56 ~ 0.16）],the difference was statistically significant（P 〈 0.01）;mean arterial pressure between the two groups（MAP）,heart rate（HR） at different time point,no significant difference（P 〉 0.05） between the two groups;fingertip blood oxygen saturation （SpO2） and blood gas analysis（including Ph,PaOE,PaCO2） had no significant difference（P 〉 0.05）.MV time,ICU stay, hospital stay and mortality between the two groups,the difference was not statistically significant（P 〉 0.05）.Concluslon DEX for children with MV after CHD satisfactory sedative effect,can reduce the dosage of sufentanil,hemodynamic stability, small inhibition of respiration,stop taking the medication during and after treatment no significant changes in respiration,which is an ideal sedative C1CU.