右美托咪定滴鼻镇静用于先天性心脏病患儿介入封堵手术的研究

Effects of dexmedetomidine nasal sedation in pediatric patients with congenital heart disease in transcatheter closure

目的:探讨先天性心脏病患儿介入封堵手术应用右美托咪定术前滴鼻镇静,再复合静脉麻醉对围术期影响。方法:选取行介入封堵手术的先天性心脏病患儿60例,随机分成滴鼻组(N组)和对照组(B组)。麻醉诱导前30 min N组给予右美托咪定1.5μg/kg滴鼻镇静,B组给予等量0.9%氯化钠液。记录滴鼻即刻、滴鼻后10 min、滴鼻后30 min、手术开始时及手术结束后10 min患儿的MAP、HR;镇静程度评分;手术时间、苏醒时间及丙泊酚的总用量;术后10 min、术后30 min及术后60 min患儿麻醉苏醒期躁动评分;不良反应的发生率。结果:术中N组丙泊酚用量低于B组(P<0.05)。两组在各时间点HR,MAP差异无统计学意义(P>0.05)。N组患儿与家长分离时镇静评分高于B组(P<0.05)。N组在术后10 min,30 min的躁动评分均低于B组(P<0.05)。结论:先天性心脏病患儿介入封堵手术应用右美托咪定术前滴鼻镇静,再复合静脉麻醉可减轻患儿术前焦虑,增强麻醉效果,减少术中丙泊酚的用量,同时可减轻小儿术后躁动,使苏醒过程更加平稳。

Objective: To investigate the influence of the preoperative use of dexmedetomidine along with total intravenous anesthesia on pediatric patients with congenital heart disease in transcatheter closure. Methods: Sixty children,having congenital heart disease who were scheduled for transcatheter closure were randomly allocated into two groups. Group N received 1.5μg/kg dexmedetomidine intranasally 30 minutes before the operative while Group B recieved normal saline. The mean arterial pressure and heart rate were recorded after the intranasal administration, 10 minutes after administration, 30 minutes after administration, at the beginning of the operation and 10 minutes after the surgery. The scores of sedation status were recorded when patients were taken away from their parents. Operation time, recovery time, total amount of propofol and the rate of adverse reaction were recorded. Pediatric anesthesia emergence delirium scale were recorded 10 minutes, 30 minutes and 60 minutes after surgery. Results: Compared with group B, the total amount of porpofol and the PAED Scale at 10,30 minutes after surgery in group N were decreased(P<0.05). The scores of sedation status in group N were increased(P<0.05). The deference of HR and MAP in two groups didn’t have statistical significance(P>0.05). Conclusions: The preoperative use of dexmedetomidine on pediatric patients with congenital heart disease in transcatheter closure may relief patients’ preoperative anxiety along with satisfied perioperative sedative outcome and less use of propofol. Also it may contribute to a more stable recovery process and less postoperative dysphoria.