右美托咪定复合艾司氯胺酮滴鼻用于先天性心脏病患儿术前镇静的效果  

Efficacy of combination of intranasal dexmedetomidine and esketamine for preoperative sedation in pediatric patients with congenital heart diseases

作　　者：曹泷尹 邱林[2] 郎志斌[2] 李雪[2] 范太兵[3] 林洪启[2] 纪宏文[4] Cao Longyin;Qiu Lin;Lang Zhibin;Li Xue;Fan Taibing;Lin Hongqi;Ji Hongwen(Department of Anesthesia and Perioperative Medicine,Zhengzhou University People's Hospital,Zhengzhou 450003,China;Department of Anesthesiology,Fuwai Central China Cardiovascular Hospital,Heart Center of Henan Provincial People's Hospital,Center China Fuwai Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Children's Heart Center,Fuwai Central China Cardiovascular Hospital,Heart Center of Henan Provincial People's Hospital,Center China Fuwai Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Anesthesiology,Fuwai Hospital Chinese Academy of Medical Science,Peking Union Medical College,Beijing 100037,China)

机构地区：[1]郑州大学人民医院麻醉与围术期医学科,450003 [2]郑州大学华中阜外医院,河南省人民医院心脏中心,华中阜外医院麻醉科,450000 [3]郑州大学华中阜外医院,河南省人民医院心脏中心,华中阜外医院儿童心脏中心,450000 [4]中国医学科学院,北京协和医学院,阜外医院麻醉科,100037

出　　处：《中华麻醉学杂志》2021年第12期1491-1494,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价右美托咪定复合艾司氯胺酮滴鼻用于先天性心脏病患儿术前镇静的效果。方法选择择期全身麻醉下行心脏手术的左向右分流型先天性心脏病患儿50例,年龄1~3岁,ASA分级Ⅱ或Ⅲ级,采用随机数字表法将患儿分为2组(n=25):右美托咪定滴鼻组(D组)鼻内滴入右美托咪定3.9μg/kg;右美托咪定复合艾司氯胺酮滴鼻组(DK组)鼻内滴入右美托咪定3.3μg/kg、艾司氯胺酮2 mg/kg。于给药前和给药后30 min时记录威斯康星州儿童医院镇静量表评分(CHW评分)、SpO_(2)、HR、肺动脉收缩压(PAP),并计算给药后SpO_(2)、HR、PAP的下降率。记录镇静起效时间,镇静过程中恶心呕吐、心动过缓、呼吸抑制等不良反应发生情况。结果2组均未见镇静不足和镇静过深。与D组比较,DK组给药后30 min时CHW评分降低,镇静起效时间缩短,HR下降率降低(P<0.05),给药前后HR、SpO_(2)、PAP差异无统计学意义(P>0.05)。DK组发生恶心呕吐2例,症状轻微,无需给药干预。2组均未见心动过缓、呼吸抑制等其他不良反应发生。结论右美托咪定复合艾司氯胺酮滴鼻可优化先天性心脏病患儿术前镇静效果,艾司氯胺酮有诱发恶心呕吐的可能,镇静时应严格把握禁饮食时间。Objective To evaluate the efficacy of combination of intranasal dexmedetomidine and esketamine for preoperative sedation in pediatric patients with congenital heart disease.Methods Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ pediatric patients,aged 1-3 yr,undergoing elective cardiac surgery for left-to-right shunt type congenital heart diseases,were divided into dexmedetomidine group(group D,n=25)or dexmedetomidine combined with esketamine group(group DK,n=25)using a random number table method.Dexmedetomidine 3.9μg/kg was intranasally delivered in group D.Dexmedetomidine 3.3μg/kg combined with esketamine 2 mg/kg was intranasally administered in group DK.The Children's Hospital of Wisconsin Sedation Scale score,SpO_(2),HR,and pulmonary artery systolic pressure(PAP)were recorded before and at 30 min after administration,and the rate of decrease in SpO_(2),HR and PAP after administration was calculated.The onset time of sedation and occurrence of adverse effects such as nausea and vomiting,bradycardia and respiratory depression during sedation were recorded.Results Inadequate sedation and over-sedation were not observed in either group.Compared with group D,Children's Hospital of Wisconsin Sedation Scale scores were significantly decreased at 30 min after administration,the onset time of sedation was shortened,and the decrease rate of HR was decreased in group DK(P<0.05),and there were no significant changes in HR,SpO_(2) and PAP before and after administration(P>0.05).In group DK,nausea and vomiting occurred in 2 cases,but the symptoms were mild and no medication intervention was needed.No other adverse effects such as bradycardia and respiratory depression were found in either group.Conclusion Combination of intranasal dexmedetomidine and esketamine can optimize the efficacy of preoperative sedation in pediatric patients with congenital heart disease,esketamine may induce nausea and vomiting,and the fasting time should be strictly controlled during sedation.

关 键 词：右美托咪啶 氯胺酮 投药 鼻内 心脏缺损 先天性 儿童 术前用药法 清醒镇静 

分 类 号：R726.1[医药卫生—儿科]