右美托咪定对婴幼儿心脏手术围术期心功能的影响

Effects of dexmedetomidine on cardiac function in infants and young children during cardiac surgery

目的探讨右美托咪定对婴幼儿心脏手术围术期心功能及血浆皮质醇(CORT)、肾上腺素(E)、去甲肾上腺素(NE)水平的影响。方法选取在体外循环下行心脏手术的先天性心脏病患儿70例,随机分为试验组和对照组,各35例。试验组在麻醉诱导前给予负荷剂量的右美托咪定0.5μg·kg-1(0.4μg·kg-1·h-1的速率持续泵注至手术结束);对照组给予等量生理盐水。比较主动脉开放后12 h(T3)2组的的心搏指数(SI)、心脏指数(CI)、左室做功指数(LCWI)及血浆CORT、E、NE水平;比较2组患儿围手术期药物不良反应发生情况。结果 T3时,试验组与对照组SI分别为(49.46±6.37),(38.96±4.65)mL·m-2;CI分别为(4.47±1.38),(3.46±0.72)L·min-1·m-2;LCWI分别为(4.19±0.79),(3.49±0.87)L·min-1·m-2;血浆CORT水平分别为(79.64±7.21),(136.52±9.84)g·dL-1;血浆E水平分别为(146.49±11.32),(159.86±13.02)pg·dL-1;血浆NE水平分别为(239.65±12.31),(283.11±15.02)pg·dL-1,差异均有统计学意义(均P<0.05)。试验组和对照组的药物不良反应发生率分别为22.86%(8例/35例)和14.29%(5例/35例),差异无统计学意义(P>0.05)。结论右美托咪定可改善婴幼儿心脏手术围术期心功能,且不增加药物不良反应发生率。

Objective To investigate the effect of dexmedetomidine on cardiac function and plasma cortisol(CORT), epinephrine(E) and norepinephrine(NE) levels in infants and young children during cardiac surgery. Methods 70 children with congenital heart disease who underwent cardiopulmonary bypass were randomly assigned to the treatment group and the control group, with 35 cases in each group. The treatment group was given a loading dose of dexmedetomidine 0.5 μg·kg-1 before the induction of anesthesia(the rate of 0.4 μg·kg-1·h-1 was continuously pumped until the end of the operation);the control group was given the same amount of normal saline. The stroke index(SI), cardiac index(CI), left cardiac work index(LCWI) and plasma CORT, E, NE levels were compared 12 h(T3) after aortic opening;The incidence of adverse reactions during perioperative period was compared between the 2 groups. Results At T3, the SI of the treatment and control groups were(49.46±6.37)(38. 96 ± 4. 65) m L·m-2;CI were(4. 47 ± 1. 38),(3. 46 ± 0. 72) L·min-1·m-2;LCWI were(4. 19 ± 0. 79),(3. 49 ± 0. 87) L·min-1·m-2;plasma CORT levels were(79. 64 ± 7. 21),(136. 52 ± 9. 84) g·dL-1;plasma E levels were(146. 49 ± 11. 32),(159. 86 ± 13. 02) pg · dL-1;plasma NE levels were(239. 65 ± 12. 31),(283. 11 ± 15. 02) pg·dL-1,the differences were statistically significant(all P < 0. 05). The incidence of adverse drug reactions in the treatment group and the control group were 22. 86%(8 cases/35 cases) and 14. 29%(5 cases/35 cases),and the difference was not statistically significant(P > 0. 05). Conclusion Dexmedetomidine can improve the perioperative cardiac function of infants and young children in cardiac surgery without increasing the incidence of adverse drug reactions.