右美托咪定对小儿先天性心脏病外科手术麻醉血流动力学的影响

目的探讨右美托咪定对小儿先天性心脏病外科手术麻醉过程中血流动力学的影响。方法将68例在体外循环下行心脏手术的先天性心脏病患儿按随机数字法随机分为咪达唑仑组(n=34)和右美托咪定组(n=34)。麻醉诱导:两组均给予咪达唑仑0.2 mg/kg、芬太尼10μg/kg、维库溴铵0.2 mg/kg行麻醉诱导。麻醉诱导后,行气管内插管,机械通气。麻醉维持:咪达唑仑组输注咪达唑仑0.2 mg.kg-1.h-1和芬太尼10μg.kg-1.h-1,1 h后分别以0.1μg.kg-1.h-1和5μg.kg-1.h-1维持;右美托咪定组输注右美托咪定1μg.kg-1.h-1和芬太尼10μg.kg-1.h-1,1 h后分别以0.5μg.kg-1.h-1和5μg.kg-1.h-1维持。必要时以0.4%～1.0%异氟醚吸入维持麻醉。监测并记录记录麻醉诱导前、麻醉后1 h、切皮前、切皮后即刻、手术结束即刻、手术结束后10 min的血压和心率。结果两组患儿在输注麻醉药物1 h后,收缩压和心率均显著降低,差异有统计学意义(均P<0.05);在切皮时,咪达唑仑组收缩压、舒张压和心率较切皮前明显增高,且明显高于右美托咪定组,差异有统计学意义(均P<0.05);右美托咪定组较少患儿需加用异氟醚,与咪达唑仑组比较,差异有统计学意义35.3%(12/34)vs.85.3%(29/34),χ2=17.752,P=0.000]。结论与咪达唑仑比较,右美托咪定可更有效的维持小儿先天性心脏病外科手术麻醉过程中的血流动力学稳定。

Aplication of dexmedetomidine on hemodynamics in pediatric patients with congenital heart disease undergoing cardiac surgery

Objectives To explore the effect of dexmedetomidine on hemodynamics in pediatric patients with congenital heart disease undergoing cardiac surgery. Methods Totally 68 pediatric patients with congenital heart disease undergoing cardiac surgery were randomly divided into the midazolam combined with fentanyl group （midazolam group, n=34） and the dexmedetomidine combined with fentanyl group （dexmedetomidine group,n=34）. In both groups, anesthesia was induced via intravenous administration of midazolam 0.2 mg/kg, fentanyl l0 kug/kg and vecuronium 0.2 mg/kg. After anesthesia induction, endotracheal intubation was performed with mechanical ventilation. In midazolam group, anesthesia was maintained with an intravenous injection of midazolam 0.2 mg·kg-1· h-1 and fentanyl 10 μg·kg-1·h-1 during the first hour, followed by a rate of 0.1 μg·kg-1·h-1 and 5 μg·kg-1·h-1 respectively. In dexmedetomidine group, patients received dexmedetomidine 1μg·kg-1·h-1 instead of midazolam and the same dose of fentanyl to maintain. 0.5 μg·kg-1·h-1 of dexmedetomidine and 5 μg·kg-1·h-1 of fentanyl were given 1 hour afterwards. In both groups, blobd pressure （BP） and heart rate （HR） were monitored and isoflurane utilization was recorded. Results Systolic BP and HR decreased significantly in both groups 1 h after anesthesia induction （all P〈0.05）. Systolic BP, diastolic BP and HR were higher in midazolam group than those in dexmedetomidine group after skin incision （all P〈0.05）. Compared with dexmedetomidine group, more patients required isoflurane in midazolam group （all P〈0.01 ）. Conclusion Compared with midazolam for anesthesia in pediatric patients with congenital heart disease undergoing cardiac surgery, dexmedetomidine had better effect on hemodynamics.