右美托咪定滴鼻用于先天性心脏病患儿心脏彩色多普勒超声检查的镇静效果及成功率的影响因素分析

Sedation effects of intranasal dexmedetomidine and factors for sedation success in children with congenital heart disease during transthoracic echocardiography

目的 评估右美托咪定滴鼻用于先天性心脏病(简称先心病)患儿心脏彩色多普勒超声(简称彩超)检查的镇静效果,并分析影响镇静成功率的因素。方法 收集2019年9—10月在上海交通大学医学院附属上海儿童医学中心行心脏彩超检查的714例先心病患儿资料。根据纳排标准,667例患儿被纳入本研究。完善镇静前评估,并记录患儿基础生命体征后给予右美托咪定2μg/kg滴鼻,定期记录患儿意识状态和生命体征。根据患儿的Ramsay镇静评分(是否>4分)判断镇静成功与否。镇静前记录患儿的年龄、性别、体重、先心病类型、先心病手术史;镇静后每10 min记录一次患儿意识状态Ramsay评分、心率、经皮动脉氧饱和度(SpO_(2)),并记录起效时间、离院时间、不良反应等。结果 667例患儿年龄为(14.36±10.11)月龄,其中1~6月龄138例(20.7%),>6~<12月龄160例(24.0%),12~<36月龄318例(47.7%),≥36月龄51例(7.6%)。体重为(9.26±2.81)kg。紫绀型患儿33例(4.9%),非紫绀型(包括已手术纠治的紫绀型先心病)患儿634例(95.1%);有先心病手术史的患儿343例(51.4%)。患儿的禁食时间为(200.11±139.57) min,起效时间为(20.45±19.09) min,离院时间为(84.96±36.73) min。606例患儿一次镇静成功,61例患儿失败;一次镇静成功率为90.9%。单因素分析显示,年龄、体重和禁食时间为镇静成功率的影响因素(P值均<0.2)。进一步行多元logistic回归分析显示,年龄为影响镇静成功率的风险因素(P=0.019)。1~6月龄组患儿镇静成功率显著高于12~<36月龄和≥36月龄组(P值均<0.05)。患儿最常见的不良反应为心动过缓,为25例。结论 右美托咪定滴鼻可安全有效地应用于先心病患儿心脏彩超检查的镇静,1~6月龄组患儿镇静成功率显著高于其他月龄组患儿。

Objective To investigate the effect and safety of intranasal dexmedetomidine during transthoracic echocardiography in children with congenital heart disease and to analyze factors for sedation.Methods The data of 714 children with congenital heart disease who underwent echocardiography at Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University School of Medicine from September to October 2019 were collected,and 667 children were enrolled in this retrospective study according to the criteria for admission and discharge.After the presedation assessment,the children were given intranasally dexmedetomidine 2μg/kg and the awareness and vital signs were regularly recorded.The successful sedation is defined that the Ramsay sedation score is over 4.The age,gender,body weight,congenital heart disease type,surgery history,Ramsay score,heart rate,pulse oxygen saturation,sedation onset time,recovery time and adverse reactions were recorded.Results The 667 children aged(14.36±10.11)months on average,including 138 cases(20.7%)aged 1-6 months,160 cases(24.0%)aged>6-<12 months,318 cases(47.7%)aged 12-<36 months,and 51 cases(7.6%)aged≥36 months.Their average weight was(9.26±2.81)kg.There were 33(4.9%)cyanotic children and 634(95.1%)non-cyanotic children(including cyanotic congenital heart disease treated by surgery).A total of 343 children(51.4%)had a history of congenital heart disease surgery.The average fasting time was(200.11±139.57)min,the onset time was(20.45±19.09)min,and the time to emergence was(84.96±36.73)min.The success rate of sedation was 90.9%(606/667).Univariate analysis showed that age,weight and fasting time were the influencing factors of sedation success rate(all P<0.2).Multivariate logistic regression analysis showed that age was the risk factor affecting the success rate of sedation(P=0.019).The success rate of sedation in children aged 1-6 months was significantly higher than that in those aged 12-<36 months and those aged≥36 months(all P<0.05).The most common adverse event was bradycardia(25 cases).Conclusion Intranasal dexmedetomidine is effective and safe for children with congenital heart disease during transthoracic echocardiography.The success rate of sedation in children aged 1 to 6 months is significantly higher than that in other age groups.