小剂量右美托咪定在紫绀型先天性心脏病围术期的疗效与安全性

Efficacy and safety of low-dose dexmedetomidine in perioperative period of cyanotic congenital heart malformation

目的评估小剂量右美托咪定在紫绀型先天性心脏病术后镇痛镇静的疗效和安全性。方法选取2019年(7~12)月紫绀型先天性心脏病患儿(n=151)接受镇痛镇静治疗,分为常规组(瑞芬太尼+咪达唑仑治疗,n=81)和联合组(再加用右美托咪定治疗,n=70)。观察两组镇痛满意程度、儿科重症监护室(pediatric intensive care unit,PICU)停留时间等指标。结果与常规组相比,联合组镇痛效果更好(P<0.05);联合组使用的瑞芬太尼[(46±7)μg/(kg·h)vs.(28±4)μg/(kg·h)]和苯二氮卓类中咪达唑仑[(206±54)μg/(kg·h)vs.(139±21)μg/(kg·h)]用量更低(P<0.05);疼痛临时干预比例更低(P<0.05)。机械通气时间和PICU停留时间两组无明显差异。结论小剂量右美托咪定在紫绀型先天性心脏病术后镇痛镇静中具有良好效果,还可降低阿片类和苯二氮卓类药物的用量,安全可靠。

AIM To evaluate the efficacy and safety of low-dose dexmedetomidine for analgesia and sedation for infants and young children after cyanotic congenital heart malformation.METHODS Included for this single-center prospective study were 151 children with cyanotic congenital heart malformations from July to December 2019,who were divided into Remifentanil+Midazolam treatment group(conventional group,n=81 cases)and Remifentanil+midazolam+dexmedetomidine treatment group(combined group,n=70 cases).The degree of analgesia and sedation,reintubation and the length of ICU stay were compared between the two groups.RESULTS There was no significant difference in age,weight and grades of surgery between the two groups.Appropriate analgesia and sedation effects were achieved in both groups.In combined group,analgesia effect was better(P<0.05)and the dosages of opioids for remifentanil[(46±7)μg/(kg·h)vs.(28±4)μg/(kg·h)]and benzodiazepines[(206±54)μg/(kg·h)vs.(139±21)μg/(kg·h)]for Midazolam were lower.The proportion of pain control incidence in combined group was lower(P<0.05).There was no significant difference in mechanical ventilation time and length of ICU stay between the two groups.CONCLUSION Low-dose dexmedetomidine is safe and achieves good effect in analgesia and sedation after cyanotic congenital heart malformation in infants and young children.On the basis of achieving comfort effects,the dosages of opioids and benzodiazepines are also reduced.