右美托咪定滴鼻复合七氟醚吸入诱导对先天性心脏病介入封堵术患儿脑糖氧代谢及认知功能的影响

Effects of Dexmedetomidine Nasal Drops Combined with Sevoflurane Inhalation Induction on Cerebral Oxygen Metabolism and Cognitive Function in Children Undergoing Interventional Occlusion of Congenital Heart Disease

目的:探讨右美托咪定滴鼻复合七氟醚吸入诱导在先天性心脏病介入封堵术的应用价值。方法:选取2020年4月至2021年4月在我院接受介入封堵术治疗的先天性心脏病患儿87例,根据住院时间排序,奇数纳入观察组(n=44),偶数纳入对照组(n=43)。观察组术前30 min以盐酸右美托咪定注射液滴鼻,对照组给予等量生理盐水处理,后均以8%七氟醚面罩吸入诱导麻醉,5%七氟醚维持麻醉。分别记录两组患儿滴鼻前(T0)、滴鼻后10 min(T1)、滴鼻后30 min(T2)、麻醉诱导前(T3)、麻醉诱导后(T4)、手术结束时(T5)、苏醒时(T6)的心率(HR)和平均动脉压(MAP),采集患儿桡动脉和颈内静脉球部血液,计算颈内动-静脉氧含量差值(Da-jvO_(2))、脑氧摄取率(CERO_(2))、血糖差值(A-VGlu)和乳酸差值(A-VLac)。于术前24 h及术后1周、3个月、1年采用韦氏儿童智力量表第Ⅳ版(WISC-Ⅳ)评价患儿认知功能。于术后10、30、60 min采用小儿麻醉苏醒期躁动评分量表(PAED)评价患儿麻醉苏醒期躁动情况。结果:与T0~T2比较,对照组T3~T6时HR降低(P<0.05);T1~T6时,观察组HR、Da-jvO_(2)、CERO_(2)、A-VGlu及A-VLac水平均低于对照组(P<0.05)。观察组术后1周和3个月时WISC-Ⅳ评分高于对照组(P<0.05),术后10、30、60 min时PAED评分均低于对照组(P<0.05),苏醒期躁动发生率低于对照组(P<0.05)。结论:先天性心脏病介入封堵术患儿采用右美托咪定滴鼻复合七氟醚吸入诱导麻醉有助于降低术中脑糖氧代谢,减少因脑缺血、缺氧所致的认知功能损害,提高苏醒质量,且对血流动力学影响较小。

Objective:To probe into the application value of dexmedetomidine nasal drops combined with sevoflurane inhalation induction in children undergoing interventional occlusion of congenital heart disease.Methods:From Apr.2020 to Apr.2021,87 children with congenital heart disease who received interventional occlusion in our hospital were selected.According to the admission sequence,the odd number was included in the observation group(n=44),and the even number was included in the control group(n=43).The observation group was treated with dexmedetomidine hydrochloride by nasal drip 30 min before surgery,while the control group received the same amount of normal saline.After that,all patients were induced anesthesia with 8%sevoflurane mask inhalation,and 5%sevoflurane maintained anesthesia.The heart rate(HR)and mean arterial pressure(MAP)of two groups were recorded before nasal drip(T0),after nasal drip of 10 min(T1),after nasal drip of 30 min(T2),before anesthesia induction(T3),after anesthesia induction(T4),at the end of surgery(T5)and at the time of awakening(T6).The blood of radial artery and internal jugular vein bulb were collected,and the difference of internal jugular artery and vein oxygen content(Da-jvO_(2)),cerebral oxygen extraction(CERO_(2)),difference of blood glucose(A-VGlu),difference of lactate(A-VLac)were calculated.The cognitive function of children was evaluated by Wechsler intelligence scale for children-Ⅳ(WISC-Ⅳ)before surgery of 24 h,after surgery of 1 week,3 months and 1 year.At 10 min,30 min,and 60 min after surgery,the agitation during anesthesia recovery period was evaluated by pediatric anesthesia emergence delirium(PAED).Results:Compared with T0 to T2,the HR of control group decreased significantly from T3 to T6(P<0.05).From T1 to T6,the HR,Da-jvO_(2),CERO_(2),A-VGlu and A-VLac of the observation group were significantly lower than those of the control group(P<0.05).The WISC-Ⅳscore in the observation group was significantly higher than that in the control group after surgery of 1 week and 3 months(P<0.05).At 10 min,30 min,and 60 min after surgery,the PAED score of the observation group was significantly lower than that of the control group(P<0.05),the incidence of restlessness in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:Dexmedetomidine nasal drip combined with sevoflurane inhalation induction in children with interventional closure of congenital heart disease is helpful to reduce intraoperative cerebral oxygen metabolism,decrease cognitive impairment induced by cerebral ischemia and hypoxia,improve the quality of awakening,and has less hemodynamic impact.