右美托咪定用于小儿心脏手术后镇静镇痛作用

Postoperative use of dexmedetomidine as a sedative and analgesic agent in pediatric patients undergoing cardiac surgery

目的观察右美托咪定（dexmedetomidine，Dex）用于小儿心脏手术后镇静镇痛的可行性和效果。方法择期行房间隔缺损修补或室间隔缺损修补手术的小儿患者40例，1岁-7岁，体重8kg-25妇，美国麻醉医师协会（ASA）分级I一Ⅱ级，采用随机数字表法分为Dex组（D组）和对照组（N组），每组20例。D组于手术结束缝皮前经静脉持续注射Dex0．3μg·kg-1．h-1，持续至术后24h。N组静脉持续注射等剂量生理盐水。观察术后4、8、12、16、24h患者的FLACC评分和Ramsay评分。当FLACC评分〉6分或Ramsay评分为1分时，静脉给予咪达唑仑0．1mg／kg。记录术后24h两组患者咪达唑仑使用次数和使用量，并观察术后有无呼吸抑制、心动过缓等并发症。结果在术后8、12、16、24hFLACC评分D组（2，2，2，3）（中位数）低于N组（5，5，6，5），Ramsay评分D组（3，2，2，2）高于N组（2，1，1，1），术后24h咪达唑仑使用次数和使用量D组（O次，0mg／kg）也少于N组（3次，0-3mg／kg）（中位数），差异有统计学意义（P〈0．05）。两组患者术后均未见相关并发症。结论d＇JbL＇脏手术后使用0．3μg·kg-1．h-1 Dex可在术后早期提供良好镇静、镇痛作用，且无其他副作用。

Objective To observe the feasibility and effect of the postoperative use of dexmedetomidine （Dex） on postoperative sedation and analgesia in pediatric patients undergoing cardiac surgery. Methods Forty pediatric patients undergoing elective atrial septum defect repair or ventricular septal defect repair surgery, aged 1-7 years old, with body weight 8 kg-25 kg and ASA I -II level, were enrolled, and randomly divided into two groups, the experimental group and the control group, 20 cases in each group. The patients assigned to experimental group received a continuous infusion of Dex, dose of 0.3 p.g＇kg~＇h1, starting at the beginning of seam the skin and continuing for 24 h postoperation, and isodose normal sodium as placebo was infused to the control group patients. The FLACC scores and the Ramsay scores were recorded at 4, 8, 12, 16, 24 h postoperatively by a nurse blind to the grouping. Once the FLACC score was over 6 or the Ramsay scores reach to 1, midazolam 0.1 mg/kg was injected intravenously. The mean artery pressure and heart rate were recorded at the corresponding time points. The dose and times of midazolam use were recorded. Postoperative complications, such as respiratory depression and bradycardia, were observed during the first 24 h after surgery. Results Compared with the control group, the FLACC scores were lower [（2, 2, 2, 3） vs （5, 5, 6, 5）] and the Ramsay scores were higher [（3, 2, 2, 2） vs （2, 1, 1, 1）] in the experimental group at the 8, 12, 16, 24 h postoperatively （median, experimental vs control, P〈O.05）, and the times and doses of midazolam use throughout 24 h were lower respectively （median, experimental vs control： times： 0 vs 3, doses： 0 mg/kg vs 0.3 mg/kg, P〈0.05）. Neither postoperative respiratory depression nor bradycardia was identified. - Conclusions Continuous infusion of Dex with a dose of 0.3 I^g＇kgl＂h1 may provide good postoperative pain relief and sedation in pediatric patients undergoing cardiac surgery. No adverse effects were observed.