右美托咪定在小儿先心病手术快通道麻醉中的应用

Application of dexmedetomidine in fast-track anesthesia for pediatric congenital heart disease surgery

目的探讨右美托咪定(Dex)在小儿先心病手术快通道麻醉(FTCA)中的应用价值。方法选择2016年4月至2018年3月在深圳市儿童医院行小儿先心病手术FTCA患儿100例,采用随机数表法将患者分为观察组和对照组,每组50例。在右颈内静脉及桡动脉均置管成功后,观察组接受初始剂量为1.0μg/(kg·h)的Dex静脉泵注,随后以0.75μg/(kg·h)的速度泵注直至手术结束;对照组则泵注相同容量的生理盐水。检测对比两组患儿的血流动力学、应激反应程度和动静脉血乳酸浓度。统计对比两组患儿的躁动发生情况和术后情况。结果在Dex给药后10 min(T1)、切皮时(T2)、锯胸骨时(T3)、体外循环结束时(T4)和气管插管拔管时(T5)观察组患儿的心率和平均动脉压均明显低于对照组,差异均有统计学意义(P<0.05);观察组患儿在T3、T4和T5时的血糖浓度水平均明显低于对照组,差异均有统计学意义(P<0.05);在T4和术后2 h时,观察组患儿的动脉血乳酸浓度、静脉血乳酸浓度和乳酸差均明显低于对照组,差异均有统计学意义(P<0.05);观察组患儿的躁动总发生率为16.0%,明显低于对照组的34.0%,差异有统计学意义(P<0.05);观察组患儿的住院时间和住院费用分别为(6.35±2.02)d和(4.73±0.25)万元,均明显少于对照组的(7.42±2.48)d和(4.91±0.31)万元,差异有统计学意义(P<0.05)。结论 Dex可改善FTCA患儿的血流动力学,减轻应激反应程度,改善脑微循环代谢,降低躁动总发生率,缩短住院时间和减少住院费用。

Objective To investigate the application value of dexmedetomidine（Dex） in fast-track cardiac anesthesia（FTCA） for pediatric congenital heart disease surgery. Methods A total of 100 children who underwent FTCA for pediatric congenital heart disease surgery from April 2016 to March 2018 in Shenzhen Children＇s Hospital were randomly divided into an observation group and a control group according to the random number table method（50 cases in each group）. After successful catheterization of the right internal jugular vein and the radial artery, the observation group received initial doses of 1 μ g/（kg·h） Dex via intravenous infusion pump, then maintained continuously at an identical dose of 0.75 μg/（kg·h） until the end of the operation; the control group was pumped the same volume of normal saline.The hemodynamics, degree of stress response and arteriovenous concentration of lactate were compared between the two groups. Statistical comparison was conducted in the occurrence of postoperative agitation and postoperative conditions between the two groups. Results The heart rate and the mean arterial pressure of the children in the observation group were significantly lower than those of the control group at different time-points： 10 minutes after Dex administration（T1）, skin incision（T2）, saw sternum（T3）, end of cardiopulmonary bypass（T4）, as well as endotracheal tube extubation（T5）, and all differences were statistically significant（P〈0.05）. The levels of blood glucose in the observation group were significantly lower than those in the control group of children at T3, T4 and T5（P〈0.05）; the arterial blood lactate concentration, venous blood lactate concentration and the lactate concentration differences in the observation group were significantly lower than those in the control group at T4 and 2 h after operation（P〈0.05）; the total incidence of agitation in the observation group was 16.0%, significantly lower than that of 34.0% in the control group（P〈0.05）; the length of hospital stay and hospitalization expenses of the observation group were（6.35±2.02） days and（4.73±0.25） ten thousand yuan, which were significantly less than（7.42±2.48） days and（4.91±0.31） ten thousand yuan for the control group（P〈0.05）. Conclusion Dex can improve the hemodynamics in children undergoing FTCA, reduce the degree of stress response, improve cerebral microcirculation and metabolism, reduce the overall incidence of agitation, shorten hospital stays, and reduce hospitalization expenses.