右美托咪定对行体外循环下心室间隔缺损修补术患儿的影响

Effects of Dexmedetomidine on infants undergoing ventricular septal defect repair under cardiopulmonary bypass

目的:探究右美托咪定对行体外循环下心室间隔缺损修补术患儿的影响。方法:选取58例行体外循环下心室间隔缺损修补术的患儿作为观察对象,采用随机数字表法将患儿分为观察组和对照组各29例。两组患儿均行全身麻醉,观察组患儿麻醉诱导前加用0.5ug/kg右美托咪定(注入时间超过10min),然后以0.4μg/(kg·h)速率维持麻醉至术毕。比较两组患儿手术时间、心肌损伤指标物水平及血流动力学的改变。设定麻醉诱导前为T0,主动脉开放1、7、24h分别为T1、T2、T3。结果:(1)观察组患儿手术时间、主动脉阻断时间、体外循环时间与对照组相比,差异无统计学意义(P>0.05);观察组患儿心脏停跳时间为(36.9±5.1)s短于对照组的(47.6±6.9)s,差异有统计学意义(P<0.05)。(2)T0时刻,观察组患儿IL-6、TNF-α、GP-BB、cTnI水平与对照组比较,差异无统计学意义(P>0.05);T1、T2、T3时刻,观察组和对照组患儿IL-6、TNF-α、GP-BB、cTnI水平均较T0时刻明显升高,差异有统计学意义(P<0.05),观察组IL-6、TNF-α、GP-BB、cTnI水平均低于对照组,差异有统计学意义(P<0.05)。(3)术前,组间SP、BP、HR水平比较,差异无统计学意义(P>0.05);术中、术毕,两组SP、DP、HR水平与术前相比,差异有统计学意义(P<0.05),术毕,观察组SP、DP、HR水平与对照组相比,差异有统计学意义(P<0.05)。结论:麻醉诱导前予以右美托咪定有利于术后婴儿心脏自主复跳,降低心肌损伤,维持患儿血流动力学稳定。

Objective:To investigate effects of Dexmedetomidine on children undergoing ventricular septal defect repair under cardiopulmonary bypass.Methods:58 children undergoing ventricular septal defect repair under cardiopulmonary bypass were selected as the study subjects.These children were divided into observation group and control group with 29 cases in each group by using the random number table method.Both groups were given general anesthesia.The observation group received 0.5 UG Dexmedetomidine(injection time exceeded 10 min)before induction of anesthesia,and then maintained the anesthesia at a rate of 0.4 ug/(kg·h)until the end of operation.The operation time,myocardial injury indexes and hemodynamic changes were observed in the two groups.Results:(1)There were no significant differences in the operation time,aortic clamping time and cardiopulmonary bypass time between the observation group and the control group(P>0.05).The cardiac arrest time of the observation group was(36.9±5.1)s,which was shorter than that of the control group of(47.6±6.9)s,and the difference was statistically significant(P<0.05).(2)At T0,the levels of IL-6,TNF-α,GP-BB,and cTnI in the observation group were not significantly different from those in the control group(P>0.05).At T1,T2,and T3,the levels of IL-6,TNF-α,GP-BB and cTnI in the observation group and the control group were significantly higher than those in at T0,and the differences were statistically significant(P<0.05).Further,the levels of IL-6,TNF-α,GP-BB and cTnI of the study group were lower than those of the control group,and the differences were statistically significant(P<0.05).(3)Before the operation,there were no significant differences in the levels of SP,BP and HR between the two groups(P>0.05).However,the levels of SP,BP and HR during the operation and after the operation were significantly different from those before the operation(P<0.05);and after the operation,there were significant differences in these indexes between the two groups(P<0.05).Conclusions:The application of Dexmedetomidine before induction of anesthesia can promote spontaneous cardiac re-beating of the infants after the operation,reduce the myocardial injury,and maintain the hemodynamic stability.