两种右美托咪定用药方案在小儿经皮房间隔缺损封堵术中的临床应用效果观察

Effects of two regimens of dexmedetomidine on percutaneous closure of atrial septal defects in children

目的评价单用右美托咪定与右美托咪定复合丙泊酚2种用药方案在小儿经皮房间隔缺损封堵术中的临床应用效果。方法回顾性纳入2018年1月至2019年10月于中国医学科学院阜外医院外科手术室行经胸超声引导下经皮房间隔缺损封堵术的患儿。根据右美托咪定用药方法不同,将患儿分为单用右美托咪定组(D组)和右美托咪定复合丙泊酚组(D+P组)。比较2组患儿麻醉相关数据和不同时点心率、收缩压、舒张压及围术期并发症发生情况。结果本研究共纳入患儿191例,其中D组93例,D+P组98例。D组患儿右美托咪定用量明显高于D+P组[(3.4±1.3)μg/kg比(1.7±0.6)μg/kg],差异有统计学意义(P<0.001)。2组患儿给药前和给药后5、10、20 min及手术结束时组间心率、收缩压、舒张压比较差异均无统计学意义(均P>0.05)。D组患儿术后躁动、围术期窦性心动过速发生率均明显低于D+P组[10.8%(10/93)比21.4%(21/98)、1.1%(1/93)比9.2%(9/98)],差异有统计学意义(均P<0.05)。结论在小儿经皮房间隔缺损封堵术中,单用右美托咪定与右美托咪定复合丙泊酚2种用药方案均能满足手术要求。单独应用右美托咪定进行镇静麻醉,能够减少患儿术后躁动及窦性心动过速的发生。

Objective To evaluate the clinical effect of dexmedetomidine alone and dexmedetomidine combined with propofol on percutaneous closure of atrial septal defect in children.Methods Children who underwent transthoracic ultrasound-guided percutaneous closure of atrial septal defect in Surgical Operation Room,Fuwai Hospital,Chinese Academy of Medical Sciences from January 2018 to October 2019 were retrospectively included.According to the different medication methods of dexmedetomidine,the children were divided into dexmedetomidine alone group(group D)and dexmedetomidine combined with propofol group(group D+P).The anesthesia data,heart rate,systolic blood pressure,diastolic blood pressure and perioperative complications were compared between the two groups.Results A total of 191 children were enrolled in this study,including 93 cases in group D and 98 cases in group D+P.The dosage of dexmedetomidine in group D was significantly higher than that in group D+P[(3.4±1.3)μg/kg vs(1.7±0.6)μg/kg](P<0.001).There were no significant differences in heart rate,systolic blood pressure and diastolic blood pressure between the two groups before administration,and 5,10,20 min after administration and at the end of operation(all P>0.05).The incidences of postoperative agitation and perioperative sinus tachycardia in group D was significantly lower than that in group D+P[10.8%(10/93)vs 21.4%(21/98),1.1%(1/93)vs 9.2%(9/98)](both P<0.05).Conclusions For the children undergoing percutaneous closure of atrial septal defects,two different regimens of dexmedetomidine both can meet the surgical requirements,and sedation anesthesia with dexmedetomidine alone can reduce the incidences of postoperative agitation and sinus tachycardia.