术中正性肌力药物选择对法洛四联症根治术后早期恢复的影响

Effect of intraoperative inotropes on the short-term outcomes of children under⁃going repair of tetralogy of Fallot

目的总结分析法洛四联症根治术中使用肾上腺素与使用多巴胺和多巴酚丁胺合剂(多巴合剂)对患儿术后早期恢复的影响。方法回顾性分析本院2017年2月至2018年2月行法洛四联症根治术的患儿186例。根据首选用药的不同分为两组:首选多巴合剂组和首选肾上腺素组,比较两组术后生化指标和早期预后指标。结果两组基线资料一致,与多巴合剂组相比,肾上腺素组术后2 h的血糖(P=0.015)和乳酸水平(P=0.000)显著增高,需要二次气管插管率显著增高(P=0.047),两组术后机械通气时间、重症监护室停留时间、其他主要并发症发生率均无显著性差异(P>0.05)。在达到等效剂量时,多巴合剂组与肾上腺素组相比,增加另一种正性肌力药的患儿人数较少(P=0.025)。结论法洛四联症根治术患儿术中使用肾上腺素对于维持血流动力学稳定和术后早期恢复方面,不优于多巴合剂。

Objective To summarize and analyze the intraoperative prophylactic usages of epinephrine versus dopamine and dobutamine mixture(DOPA-mix)in children undergoing repair of tetralogy of Fallot.Methods 186 children with repair of tetralogy of Fallot from February 2017 to February 2018 were analyzed retrospectively.According to different first-line intraoperative inotrope ad⁃ministration patterns,the patients were divided into DOPA-mix group and epinephrine group.Results The baseline data of two groups were comparable.The blood glucose(P=0.015)and lactate levels(P=0.000)were higher in the epinephrine group 2 hours after operation,and the re-intubation rate was higher in the epinephrine group(P=0.047).With equivalent dose achieved,less patients in the DOPA-mix group than in the epinephrine group required additional inotropes(16%vs 30%,P=0.025).No difference in other intraoperative outcomes was found between the two groups.Conclusion Compared with DOPA-mix used in children undergoing re⁃pair of tetralogy of Fallot,epinephrine did not have superior perioperative hemodynamics or in-hospital outcomes.