右美托咪定对心肺转流心内直视手术患儿血流动力学及应激反应的影响  

Effects of dexmedetomidine on hemodynamics and stress reaction in pediatric patients with congenital heart disease undergoing open heart surgery with cardiopulmonary bypass

作　　者：李晓松[1] 刘海涛[1] 任建军[1] 董振明[1] 

机构地区：[1]河北医科大学第二医院麻醉科,石家庄市050000

出　　处：《临床麻醉学杂志》2012年第10期958-960,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察右美托咪定连续输注对小儿先天性心脏病CPB心内直视手术期间的血流动力学及应激反应的影响。方法 CPB心内直视矫治手术患儿30例,ASAⅡ或Ⅲ级,随机均分为右美托咪定组(D组)和对照组(C组)。D组接受初始剂量为1.0μg/kg的右美托咪定(给药时间大于10min),随后以0.5～1.0μg·kg-1·h-1的速度维持直至手术结束,C组则给予相同容量的生理盐水。分别于给药前(T0)、给药后10min(T1)及15min(T2)、切皮后(T3)、锯胸骨后(T4)、停CPB后(T5)、手术结束时(T6)记录血流动力学参数,并分别于T0、T4～T6时检测血糖(Glu)、皮质醇(Cor)、去甲肾上腺素(NE)和肾上腺素(E)浓度。结果与C组比较,T1～T6时D组HR减慢,SBP、DBP及MAP明显降低,以T2时降低最为显著(P<0.05)。与T0时比较,T4～T6时两组的Glu、Cor、NE及E浓度显著增加(P<0.05),并以T5时升高最为显著,但与C相比较,D组明显降低(P<0.05)。结论右美托咪定连续输注能够缓解小儿先天性心脏病CPB心内直视手术时的血流动力学及应激激素水平的变化,从而减轻心内直视手术和CPB的应激反应。Objective To evaluate the effects of dexmedetomidine infusion on hemodynamic and stress reaction in pediatric patients with congenital heart disease undergoing open heart surgery with cardiopulmonary bypass. Methods Thirty pediatric patients undergoing open heart surgery with eardiopulmonary bypass, ASA class II or III, were randomly assigned to two groups： the group DEX （group D, n=15） and the group control （group C, n= 15）. Patients in group D received an initial bolus dose of dexmedetomidine （1.0μg/kg） over 10 minutes, immediately followed by a continuous infusion of 0. 5-1.0μg. kg-1. h-1 until the end of the operation. The same volume of normal saline was given in the control group. Hemodynamic parameters and concentrations of blood glucose, eortisol, norepinephrine and epinephrine were measured before injection（T0）, 10 min and 15 rain after administration（T1 and T2 ）, after incision （T3）, after sternum saw （T4）, after CPB （T5） and immediately after surgey （T6）. Results The values of HR, SBP, DBP and MAP decreased significantly at T1-T6 in group D, and were significantly lower than those in group C, especially at T2 （P〈0. 05）. In both groups, blood glucose, plasma cortisol, norepinephrine and epinephrine increased significantly at T4-T6. However, the values were lower in group D compared with those in group C（P d0. 05 ）. Conclusion Intraoperative dexmedetomidine infusion attenuated the hemodynamic and neuroendocrinal response to surgical trauma and eardiopulmonary bypass in pediatric patients undergoing corrective surgery for congenital heart disease.

关 键 词：右美托咪定 血流动力学 应激反应 儿茶酚胺 

分 类 号：R726.1[医药卫生—儿科]