盐酸右美托咪定在小儿体外循环心内直视手术快通道麻醉中的应用  

Application of dexmedetomidine in fast-track anesthesia for children undergoing cardiac surgery with cardiopulmonary bypass

作　　者：周晓辉[1] 郭琼梅[1] 王莉[1] 张泽[1] 魏砚砚[1] 周长浩[1] ZHOU Xiao-hui;GUO Qiong-mei;WANG Li;ZHANG Ze;WEI Yan-yan;ZHOU Chang-hao(Department of Anetheiology,the First Hospital of Hebei Medical University,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院麻醉科,河北石家庄050031

出　　处：《河北医科大学学报》2018年第12期1447-1450,1454,共5页Journal of Hebei Medical University

基　　金：河北省科技计划项目(16277778D)

摘　　要：目的观察右美托咪定在小儿体外循环(cardiopulmonary bypass,CPB)心内直视手术快通道麻醉中的作用。方法将年龄1～3岁、ASA分级Ⅱ或Ⅲ级择期CPB下行先天性心脏病手术患儿60例按随机数字表法分为右美托咪定快通道麻醉组(D组)30例和常规快通道麻醉组(C组)30例。D组诱导前泵入右美托咪定初始剂量1μg/kg(给药时间15min),术中泵注维持剂量右美托咪定0.4μg·kg-1·h-1,C组同样的方法给予等容量生理盐水。记录患儿给药前(T1)、给药后10min(T2)、切皮后(T3)、锯胸骨后5min(T4)、CPB后(T5)、拔管后(T6)6个时点的心率、收缩压、舒张压;T1,T5,T6时点血浆中肌钙蛋白I(troponin I,cTnI)、血肌酸激酶同工酶MB(creatine kinase-MB,CK-MB)浓度;患儿术中舒芬太尼和罗库溴铵用量。比较2组术后机械通气时间和住院时间。结果 D组T2～T6心率、收缩压、舒张压均较C组减低(P<0.05);D组T5,T6时cTnI、CK-MB浓度均较C组减低(P<0.05);D组舒芬太尼和罗库溴铵均较C组用量减少(P<0.05);D组机械通气时间和住院时间均较C组明显缩短(P<0.05)。结论右美托咪定用于先天性心脏病快通道麻醉可以稳定血流动力学,保护心功能,有利于患儿的恢复,减少机械通气时间和住院时间。Objective To observe the effect of dexmedetomidine on fast-track anesthesia in children opening cardiac operation by cardiopulmonary bypass（CPB）.Methods A total of 60 children patients undergoing opening cardiac operation by CPB,ASAⅡorⅢ,were randomized two groups.The 30 cases in group D were given dexmedetomidine fast-track anesthesia.The 30 cases in groups C were conventional fast-track anesthesia.Patients in group D were received an initial bolus dose of dexmedetomidine（1.0μg/kg）over 15 min,immediately followed by a comtinuous infusion of 0.4μg·kg-1·h-1 until the end of the operation.The same volume of normal saline was given in the group C.Heart rate,systolic blood pressure,diastolic blood pressue were measured before injection（T1）,10 min after administration（T2）,after incision（T3）,5 min after sternum saw（T4）,after CPB（T5）,after ectubation（T6）.The changes of cardiac troponin I（cTnI）and creatine kinase-MB（CK-MB）were measured in T1,T5,T6.Dosage of sufentanil and rocuronium during operation 、mechanical ventilation time and hospital stay length were recorded.Results Heart rate,systolic blood pressure,diastolic blood pressue were decreased at T2-T6 in group D than in group C（P〈0.05）.CK-MB and cTnI levels were decreased in group D compared to that in group C at T5,T6（P〈0.05）.The dosage of sufentanil and rocuronium in group D was lower than that in group C（P〈0.05）.Compared with group C,mechanical ventilation time and hospitalization time were significantly reduced in group D（P〈0.05）.Conclusion Dexmedetomidine can stabilize hemodynamics and protect cardiac function on fast-track anesthesia in children opening cardiac operation by CPB,which is conducive to the recovery of children and reduces mechanical ventilation time and hospitalization time.

关 键 词：心脏缺损 先天性 体外循环 右美托咪定 麻醉 

分 类 号：R541.1[医药卫生—心血管疾病] R614[医药卫生—内科学]