右美托咪定对紫绀型先天性心脏病婴幼儿体外循环应激反应的影响

发布时间：2018-04-04 01:58

本文选题：右美托咪定　切入点：婴幼儿　出处：《上海医学》2015年12期

【摘要】：目的研究右美托咪定(Dex)对紫绀型先天性心脏病(CHD)婴幼儿体外循环(CPB)手术时应激反应的影响。方法 2014年6月—2015年3月随机选择40例紫绀型CHD患儿,年龄0~3岁,按照随机数字表将患儿分入试验组和对照组,每组20例。试验组行麻醉诱导后给予Dex 1μg/kg(药物质量浓度为0.5μg/mL),注射时间10min,术中经静脉泵注射速度为0.2μg·kg~(-1)·h~(-1),直至手术结束;对照组在整个手术过程中静脉注射0.9%氯化钠溶液,注射速度、麻醉处理与试验组一致。监测患儿围术期的心率、血压。在输注Dex前(T_0)、给药后10min(T_1)、劈胸骨后(T_2)、CPB结束时(T_3)、手术结束时(T_4)各时间点,采集患儿动脉血检测皮质醇、肾上腺素、去甲肾上腺素、血糖水平。记录手术时间、CPB时间、主动脉阻断时间、ICU停留时间。结果术后所有患儿均存活,两组间手术时间、CPB时间、主动脉阻断时间的差异均无统计学意义(P值均0.05);对照组的ICU停留时间显著长于试验组(P0.05),有3例患儿的ICU停留时间10d。试验组在T_2至T4时间点的心率和平均动脉压较同组T_0和T_1时间点,以及对照组同时间点有下降的趋势,但差异均无统计学意义(P值均0.05)。试验组和对照组在T2至T4时间点的血浆皮质醇、肾上腺素、去甲肾上腺素、血糖水平均显著高于同组T0和T1时间点(P值均0.05),试验组在T2至T4时间点的血浆皮质醇、肾上腺素、去甲肾上腺素、血糖水平均显著低于对照组同时间点(P值均0.05)。结论术中连续输注Dex能够降低紫绀型CHD婴幼儿行心内直视手术CPB时应激激素水平的上升幅度,减轻由此导致的应激反应,且血流动力学稳定。
[Abstract]:Objective to study the effect of dexmetomidine Dexon on stress response during CPB in infants with cyanotic congenital heart disease (CHD) undergoing cardiopulmonary bypass (CPB).Methods from June 2014 to March 2015, 40 children with cyanotic CHD, aged 0 or 3 years, were randomly divided into two groups: experimental group and control group.After anesthesia induction, the experimental group was given Dex 1 渭 g / kg (drug concentration 0.5 渭 g / mL, injection time 10 min, intraoperative injection rate 0.2 渭 g kg / kg -1) until the end of the operation, while the control group received 0.9% sodium chloride solution intravenously during the whole operation.The anesthetic treatment was consistent with that of the experimental group.Heart rate and blood pressure were monitored during perioperative period.The arterial blood samples were collected to detect the levels of cortisol, adrenaline, norepinephrine and blood glucose at each time point before Dex injection, 10 minutes after administration, T _ (1), T _ (2) T _ (1), T _ (2) / T _ (2) T _ (3) at the end of sternum splitting, and T _ (4) at the end of operation. The arterial blood samples were collected to detect cortisol, adrenaline, norepinephrine and blood glucose levels.The operation time and CPB time, aortic occlusion time and ICU stay time were recorded.Results all the children survived after operation. There was no significant difference between the two groups in the operation time and the aortic occlusion time (P < 0.05), but the ICU residence time in the control group was significantly longer than that in the test group (P 0.05), and the ICU residence time in 3 cases was 10 days.The heart rate and mean arterial pressure in the experimental group were lower than those in the same group at the time points from T _ 2 to T _ 4, and the same time points in the control group, but there was no significant difference between the two groups (P < 0.05).The plasma cortisol, epinephrine, norepinephrine and blood glucose levels in the trial group and the control group were significantly higher than those in the same group at T 0 and T 1 time points (P < 0.05), and the plasma cortisol and epinephrine levels in the trial group at T 2 to T 4 time points were significantly higher than those in the control group.The levels of noradrenaline and blood glucose were significantly lower than those of the control group at the same time point (P < 0.05).Conclusion continuous intraoperative infusion of Dex can decrease the increase of stress hormone level in cyanotic CHD infants undergoing open heart surgery (CPB), alleviate the stress response and stabilize hemodynamics.
【作者单位】：郑州市儿童医院麻醉科;中国医学科学院北京协和医院麻醉科;
【基金】：河南省郑州市科技发展计划基金资助项目(20131036)
【分类号】：R726.1

【相似文献】