右美托咪定对不同类型先心病患儿心脏手术预后的影响研究  

Effects of Dexmedetomidine on Prognoses of Children with Different Types of Congenital Heart Disease after Surgery

作　　者：刘永哲 魏碧玉 高明龙 孙立 马亚群 徐龙河 LIU Yong-zhe;WEI Bi-yu;GAO Ming-long;SUN Li;MA Ya-qun;XU Long-he(Department of Anesthesiology,the Third Medical Center of PLA General Hospital,Beijing 10039,China;Department of Anesthesiology,Beijing Chest Hospital Affiliated to Capital Medical University,Beijing 101149,China;Department of Anesthesiology,the Seventh Medical Center of PLA General Hospital,Beijing 10010,China)

机构地区：[1]中国人民解放军总医院第三医学中心麻醉科,北京100039 [2]首都医科大学附属北京胸科医院麻醉科,北京101149 [3]中国人民解放军总医院第七医学中心麻醉科,北京100700

出　　处：《解放军医药杂志》2021年第4期81-84,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：北京市科技委员会资助项目(Z1711000000417035)

摘　　要：目的探讨围术期持续泵注不同剂量右美托咪定(Dex)对不同类型先天性心脏病(CHD)患儿预后的影响。方法选取2018年5月—2019年2月解放军总医院第七医学中心体外循环(CPB)下接受心脏手术的0~1岁的紫绀型先天性心脏病(CCHD)48例和非紫绀型先天性心脏病(ACHD)48例为研究对象。按照先天性心脏病类型及给药剂量不同分为ACHD对照组、ACHD低、中、高剂量组和CCHD对照组、CCHD低、中、高剂量组,每组12例。ACHD和CCHD对照组静脉泵注0.9%氯化钠注射液,ACHD和CCHD低、中、高剂量组均于麻醉诱导前10 min静脉泵注Dex 1μg/kg负荷剂量,随后分别以0.5、1、1.5μg/(kg·h)的Dex泵注至气管拔管。记录各组术后拔管时间、ICU停留时间及住院时间。结果CCHD低、中、高剂量组拔管时间、ICU停留和住院时间均显著短于CCHD对照组(P<0.05,P<0.01),但CCHD低、中、高剂量组间比较差异无统计学意义(P>0.05)。ACHD对照组、ACHD低、中、高剂量组各组间拔管时间、ICU停留时间及住院时间比较差异无统计学意义(P>0.05)。结论不同剂量Dex均可显著缩短CCHD患儿拔管时间、ICU停留及住院时间,且推荐剂量为0.5μg/(kg·h)。Objective To investigate effects of different doses of Dexmedetomidine(Dex)by continuing pump perfusion during perioperative period on prognoses of infants with different types of congenital heart disease(CHD).Methods A total of 48 children with cyanotic congenital heart disease(CCHD)and infants with acyanotic congenital heart disease(ACHD)were recruited as controls who were admitted during May 2018 and February 2019 at the age of 0 to 1 with cardiac surgery under cardiopulmonary bypass,and the infants were divided into ACHD control group,low,medium and high-doses ACHD groups,CCHD control group and low,medium and high-doses CCHD groups(n=12 in each group)according to CHD different types and different medications.Control group was intravenously pumped with 0.9%Sodium Chloride Injection,while ACHD group,low,medium and high-doses CCHD groups were intravenously pumped with Dex 1μg/kg loading dose at 10 minutes before induction of anesthesia,and then Dex 0.5μg/(kg·h),1μg/(kg·h)and 1.5μg/(kg·h)pump perfusion were followed by till tracheal extubation.Times of extubation,ICU stay and length of stay were recorded in each group.Results Times of extubation,ICU stay and length of stay in low,medium,and high-doses CCHD groups were significantly shorter than those in CCHD control group(P<0.05,P<0.01),but there were no statistically significant differences in the above times among low,medium and high-doses groups(P>0.05).There were no statistically significant differences in times of extubation,ICU stay and length of stay among ACHD control group,low,medium and high-doses ACHD groups(P>0.05).Conclusion Different doses of Dex may significantly shorten times of extubation,ICU stay and length of stay in infants with cyanotic congenital heart disease,and the recommended dose is 0.5μg/(kg·h).

关 键 词：右美托咪定 紫绀型先天性心脏病 非紫绀型先天性心脏病 儿童 预后 

分 类 号：R725.4[医药卫生—儿科]