右美托咪定复合舒芬太尼在婴幼儿超快通道心脏麻醉中的应用

Application of dexmedetomidine combined with sufentanil in ultra-fast track cardiac anesthesia for infants and young children

目的观察右美托咪定复合舒芬太尼在婴幼儿围术期超快通道心脏麻醉(ultra-fast track cardiac anesthesia,UFTCA)中的临床应用效果。方法纳入广州市妇女儿童医疗中心麻醉科择期行体外循环(cardiopulmonary bypass,CPB)下心内直视房间隔缺损(atrial septal defect,ASD)修补术和(或)室间隔缺损(ventricular septal defect,VSD)修补术婴幼儿130例为研究对象。采用随机数字表法将患儿分为右美托咪定UFTCA组和传统麻醉组,每组65例。UFTCA组诱导完成后持续静脉泵注右美托咪定每小时1 mcg/kg至主动脉开放,后改为每小时0.3 mcg/kg维持至术毕,术后镇痛采用右美托咪定复合舒芬太尼;传统麻醉组诱导完成后泵注相同容量的生理盐水,术后镇痛仅采用舒芬太尼。记录并比较两组患儿术中舒芬太尼用量、血流动力学指标、术后住院情况、术后FLACC疼痛评分和Ramsay镇静评分、术后2小时动脉血乳酸值(lactic acid,Lac)、氧分压(arterial partial arterial of oxygen,PaO 2)和二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO 2)。结果UFTCA组患儿术中舒芬太尼用量明显低于传统麻醉组(P<0.05)。两组患儿在麻醉诱导前(T1)、诱导后(T2)、切皮时(T3)、CPB运行中(T4)、CPB停机后(T5)、手术结束(T6)的心率(heart rate,HR)及平均动脉压(mean arterial pressure,MAP)比较差异均无统计学意义(P>0.05)。UFTCA组患儿术后拔管时间、心脏监护室(cardiac intensive care unit,CICU)住院时间、总住院时间和住院费用均明显低于传统麻醉组(P<0.05)。两组患儿术后第1~2天FLACC疼痛评分均无显著差异(P>0.05),UFTCA组患儿术后第1~2天Ramsay镇静评分均明显高于传统麻醉组(P<0.05)。UFTCA组患儿术后2小时动脉血Lac值明显低于传统麻醉组(P<0.05)。结论右美托咪定复合舒芬太尼在婴幼儿围术期UFTCA中的应用临床效果明显,可减少围术期阿片类药物的用量,维持血流动力学平稳,缩短拔管时间,提供良好的术后镇静镇痛效果,改善术后氧合平衡,且无明显不良反应。

Objective To observe the clinical effects of dexmedetomidnie combined with sufentanil in ultra-fast track cardiac anesthesia for infants and young children.Methods A total of 130 infants and young children patients undergoing opening atrial septal defect(ASD)repair and(or)ventricular septal defect(VSD)repair by cardiopulmonary bypass(CPB),were randomized into a dexmedetomidnie UFTCA group and a conventional anesthesia group according to the random number table method(65 patients in each group).Patients in UFTCA group were received a continuous infusion dose of 1 mcg/kg/h dexmedetomidine following induction until cross clamp releasing,then decreased the dose of dexmedetomidine to 0.3 mcg/kg/h until the end of the operation;the post operation analgesia was dexmedetomidine combined with sufentanil.Patients in conventional anesthesia group were received a comtinuous infusion of the same volume of normal saline until the end of the operation,the drug of analgesia was sufentanil.The doses of sufentanil,hemodynamic indexes,postoperative hospitalization conditions,scores of FLACC,scores of Ramsay and the lactic acid(Lac),arterial partial arterial of oxygen(PaO 2),arterial partial pressure of carbon dioxide(PaCO 2)2 hours post-operation were recorded and compared between the two groups.Results The dose of sufentanil in UFTCA group was significantly lower than that in conventional anesthesia group(P<0.05).There were no significant differences in the heart rate(HR)and mean arterial pressure(MAP)between the two groups at the time of before induction(T1),after induction(T2),skin incision(T3),during CPB(T4),end of CPB(T5),end of operation(T6)(P>0.05).The length of extubation post-operation,cardiac intensive care unit(CICU)stay,hospital stay and hospitalization expenses in UFTCA group were all significantly less than those in conventional anesthesia group(P<0.05).There were no significant differences in the scores of FLACC at the first and second day post-operation between the two groups(P>0.05).The scores of Ramsay in UFTCA group were significantly higher than those in conventional anesthesia group at the first and second day post-operation respectively(P<0.05).The Lac 2 hours post-operation in UFTCA group was significantly lower than that in conventional anesthesia group(P<0.05).Conclusion The application of dexmedetomidine combined with sufentanil in UFTCA for infants and young children is effective,and can decrease the perioperative dose of opioids,ensure stable hemodynamics,shorten extubation time,provide good postoperative sedation and analgesia effect,improve postoperative oxygenation balance and internal environment,with no obvious adverse reactions.