右美托咪定在小儿先心病介入封堵术中的应用

Application of Dexmedetomidine in Pediatric Patients with Congenital Heart Disease Undergoing Transcatheter Closure

目的探讨右美托咪定（dexmedetomidine,DEX）用于小儿先心病介入封堵术中镇静的可行性和安全性。方法 40例美国麻醉医师协会（American Society of Anesthesiologists,ASA）Ⅰ~Ⅱ级择期行先心病介入封堵术的患儿,随机分为DEX复合芬太尼静脉麻醉组（D组）和丙泊酚复合芬太尼静脉麻醉组（P组）,每组20例。D组10 min内静脉恒速输注DEX负荷量1μg/kg,继以1μg/（kg·h）维持至手术结束;P组10 min内静脉恒速输注丙泊酚负荷量1.5 mg/kg,继以4~6 mg/（kg·h）维持至手术结束,两组患儿均在局麻行股动脉穿刺前给予芬太尼2μg/kg。记录给药前（T0）、给药后10 min（T1）、穿刺时（T2）、放置封堵器时（T3）、苏醒后10 min（T4）的平均动脉压（mean arterial pressure,MAP）、心率（heart rate,HR）、呼吸频率（respiratory rate,RR）和脉搏血氧饱和度（pulse oxygen saturation,SpO2）,记录患儿脑电双频指数（bispectral index,BIS）降至70的诱导时间、手术时间、苏醒时间及不良反应。结果两组患儿各时段MAP、RR无明显变化（P〉0.05）;与T0比较,T1~T4时D组HR明显减慢（P〈0.05）;组间比较,T1~T4时D组HR显著低于P组（P〈0.05）。D组诱导时间大于P组（P〈0.05）,但苏醒时间明显短于P组（P〈0.05）,术中体动少于P组（P〈0.05）。结论DEX用于小儿先心病介入封堵术,具有血流动力学稳定、呼吸抑制轻、术后苏醒快的特点。

Objective To investigate the practicability and safety of dexmedetomidine in pediatric patients with congenital heart disease undergoing transcatheter cosure.Methods Fourty ASAⅠ ~ Ⅱ pediatric patients with congenital heart disease undergoing transcatheter closure were randomly divided into group D and P,20 cases in each group.Dexmedetomidine was infused with a bolus dose of 1μg/kg in 10 minutes following by 1μg/（kg·h）until the end of the surgery in group D,and propofol was used instead of dexmedetomidine with a bolus dose of 1.5 mg/kg in 10 minutes maintaining dose of 4~6 mg/（kg·h）by the end of the surgery in group P.All pediatric patients received fentanyl 2μg/kg before local anesthesia for femoral arteriopuncture.The value of mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR）and pulse oxygen saturation（SpO2）were recorded at the time of before injection of dexmedetomidine or propofol（T0）,10 min after injection（T1）,when puncture（T2）,transcatheter closure placement（T3）and 10 min after awakening（T4）.Induction time（BIS descent to 70）,operation time,awakening time and adverse reactions in two groups were recorded.Result There were no significant changes in MAP and HR in two groups（P〉0.05）,but HR obviously slowed down from T1 to T4 compared to T0 in group D（P〈0.05）.HR from T1 to T4 in group D were significantly lower than that in group P（P〈0.05）.Induction time of group D was longer but awakening time was obviously shorter than those of group P（P〈0.05）.Intraoperative body movements of group D were less than those of group P（P〈0.05）.Conclusion There are advantages of stable hemodynamics,less respiratory depression and quick awakening with the application of dexmedetomidine in pediatric patients with congenital heart disease undergoing transcatheter closure.