右旋美托咪啶和咪达唑仑联合芬太尼镇静治疗在先心病肺动脉高压患儿术后的对比研究  

Dexmedetomidine vs Midazolam/Fentanyl for sedation of children with pulmonary artery hypertension after congenital cardiac surgery

作　　者：蒋利[1] 丁盛[1] 张渝华[1] 张立平[1] 陈雪[1] 张近宝[2] 

机构地区：[1]成都军区总医院心胸外科监护病房,610083 [2]成都军区总医院心胸外科,610083

出　　处：《中华胸心血管外科杂志》2012年第8期485-487,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的对比观察右旋美托咪啶和咪达唑仑联合芬太尼镇静治疗在先心病肺动脉高压（PAH）儿童术后的效果。方法PAH术后患儿40例，根据计算机随机数字法，奇数人右旋美托咪啶治疗组（A组），偶数入咪达唑仑联合芬太尼治疗组（B组）。A组右旋美托咪啶的负荷剂量为0．5～1．0μg／kg，维持剂量为0．25～0．75μg·kg^-1·min^-1；B组咪达唑仑的负荷剂量为0．1mg／kg，维持剂量为0．5—2．0μg·kg^-1·min^-1，芬太尼的维持剂量为1．0～1．5μg·kg^-1·min^-1。对比两组患儿镇静达标时间、机械通气时间、追加镇静药物的频次、谵妄发生率，用药前、用药后10min、1h、4h、8h、12h的COMFORT评分、心率（HR）、平均动脉压（MAP）、血氧饱和度（SPO2）等指标变化。结果A、B两组患儿用药后各个时间点的COMFORT评分均比用药前显著减低，差异均有统计学意义（P〈0．01），而用药后两组患儿各时间点之间的COMFORT评分比较差异无统计学意义。两组患儿的COMFORT评分、HR、MAP和SPO：在各时间点差异均无统计学意义。A组患儿追加镇静药物的频次显著低于B组患儿[（4．3±3．3）次对（10．7±5．5）次，P〈0．01]。A组谵妄发生率显著低于B组（25％对60％），P〈0．05。两组患儿的镇静达标时间差异无统计学意义，A组患儿较B组机械通气时间短，但差异无统计学意义。结论与咪达唑仑联合芬太尼治疗相比较，单用右旋美托咪啶可在相同时间内达到满意的镇静效果，同时可以减少其他镇静药物的使用和谵妄的发生。Objective To compare dexmedetomidine with midazolam/fentanyl for sedation in children with pulmonary artery hypertension（PAil） after congenital cardiac surgery. Methods Forty children with PAIl were randomly divided into two groups after congenital cardiac surgery. The age of children ranged from 3 to 89 months, and weight ranged from 3 to 26 kg. Group A received an infusion of dexmedetomidine（Dex） 0.5 - 1.0 μg/kg bolus for induction, then a maintenance dose of Dex 0. 25 -0.75 μg·kg^-1·h -1. Group B received an infusion of midazolam 0.1 mg/kg bolus for induction, then a maintenance dose of 0. 5 - 2.0μg·kg^-1·h -1. The maintenance dose of fentanyl was 1.0 - 1.5μg·kg^-1·h -1. The time of target sedation score, duration of mechanical ventilation, frequency of using other sedatives and prevalence of delirium were compared between the two groups. Other indicators including COMFORT scale, heart rate （HR）, mean arterial pressure （MAP） and pulse oxygen saturation （ SPO2 ） were compared between the two groups among following time points ： before infusion, 10 min, 1 h, 4 h, 8 h, 12 h after infusion. Results Time points after infusion had lower COMFORT scale significantly compared with time points before infusion （26.3 ± 7.3 ） in group A （P 〈 0.01 ） , so as in group B while the COMFORT scale was 23.9 ± 5.9 before infusion. There was no statistics difference of the time to reach the target sedation score between group A and group B [ （4.4 ± 1.5 ） min vs （ 4.3 ± 1.9 ） min, P 〉 0.05 ]. The COMFORT scale had no statistic difference among the time points after infusion in the two groups. The COMFORT scale, HR, MAP and SPO2 had no statistic difference between goup A and goup B among time points before and after infusion. Frequency of using other sedatives were significantly lower in group A compare with group B （4.3 ± 3.3 vs 10.7 ± 5.5 ） （P 〈 0.01 ）. The prevalence of delirium was significantly lower in group A than group B （25% vs 60% ） （ P 〈0.05 ）. Th

关 键 词：心脏缺损 先天性 右旋美托咪啶 肺动脉高压 儿童 镇静 谵妄 

分 类 号：R726.5[医药卫生—儿科]