婴幼儿心内直视术后不同镇静方式对应激和血浆脑钠肽、心肌肌钙蛋白Ⅰ变化趋势的影响

Effects of Different Sedation Methods on Variation Trend of Stress,Brain Natriuretic Peptide and Cardiac Troponin Ⅰ After Open Heart Surgery in Infants

目的:探讨盐酸右美托咪定与咪达唑仑注射液对婴幼儿心内直视手术后应激和血浆脑钠肽(brain natriuretic peptide,BNP)、心肌肌钙蛋白Ⅰ(cardiac troponin Ⅰ,c Tn Ⅰ)变化的影响。方法:选取2012年2月—2013年10月接受心内直视畸形矫治手术的患儿78例作为研究对象,以随机数字表法分为观察组和对照组各39例。观察组患儿术后给予盐酸右美托咪定,对照组患儿术后给予咪达唑仑注射液。比较2组患儿的镇静满意率、不良反应发生率、术中主动脉阻断时间、术后机械通气时间、停药后唤醒时间的差异,观察2组患儿的血糖值、皮质醇水平、BNP、c Tn Ⅰ水平的差异及变化情况。结果:2组患儿的镇静满意率、不良反应发生率、术中主动脉阻断时间、术后机械通气时间的差异无统计学意义(P>0.05),观察组患儿停药后唤醒时间显著低于对照组,差异有统计学意义(P<0.05)。观察组患儿在术后1、4、12、48 h的血糖、皮质醇水平均显著低于对照组,观察组患儿在术后1、4、12、24、48 h的BNP、c Tn Ⅰ含量均明显低于对照组,差异均有统计学意义(P<0.05)。结论:婴幼儿心内直视手术后应用盐酸右美托咪定的镇静效果显著优于咪达唑仑注射液。

OBJECTIVE： To probe into the effects of different sedation methods on variation trend of stress,Brain natriuretic peptide（ BNP） and cardiac troponin Ⅰ（ c Tn Ⅰ） after open heart surgery in infants. METHODS： 78 infants with open heart surgery admitted from Feb 2012 to Oct. 2013 were selected to be divided into observation group and control group via the random number table,with 39 cases in each. After surgery,the observation group were given dexmedetomidine hydroch,while the control group received midazolam injection. The differences of the sedation satisfaction rate,incidence of adverse drug reactions,the aorta block of time during surgery,the duration of ventilatory support after surgery and the waking up time after drug withdraw were compared between two groups; the blood glucose level,cortisol,troponin,BNP and c Tn Ⅰ of two groups were observed. RESULTS： There was no statistical significance between two groups in the sedation satisfaction rate,incidence of adverse drug reactions,the aorta block of time during surgery and the duration of ventilatory support after surgery（ P〉0. 05）. The waking up time after drug withdraw of observation group was shorter than that of control group,with statistical significance（ P〈0. 05）. The blood glucoselevel,cortisol troponin,BNP and c Tn Ⅰ in observation group after surgery of 1,4,12 and 48 h were significantly lower than those in control group,with statistical significance（ P〈0. 05）. CONCLUSIONS： The sedation effects of dexmedetomidine hydroch in treatment of infants with open heart surgery is better than that of midazolam injection.