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目的探讨右美托咪定(dexmedetomidine,DEX)用于小儿先心病介入封堵术中镇静的可行性和安全性。方法 40例美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ~Ⅱ级择期行先心病介入封堵术的患儿,随机分为DEX复合芬太尼静脉麻醉组(D组)和丙泊酚复合芬太尼静脉麻醉组(P组),每组20例。D组10 min内静脉恒速输注DEX负荷量1μg/kg,继以1μg/(kg·h)维持至手术结束;P组10 min内静脉恒速输注丙泊酚负荷量1.5 mg/kg,继以4~6 mg/(kg·h)维持至手术结束,两组患儿均在局麻行股动脉穿刺前给予芬太尼2μg/kg。记录给药前(T0)、给药后10 min(T1)、穿刺时(T2)、放置封堵器时(T3)、苏醒后10 min(T4)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、呼吸频率(respiratory rate,RR)和脉搏血氧饱和度(pulse oxygen saturation,SpO2),记录患儿脑电双频指数(bispectral index,BIS)降至70的诱导时间、手术时间、苏醒时间及不良反应。结果两组患儿各时段MAP、RR无明显变化(P>0.05);与T0比较,T1~T4时D组HR明显减慢(P<0.05);组间比较,T1~T4时D组HR显著低于P组(P<0.05)。D组诱导时间大于P组(P<0.05),但苏醒时间明显短于P组(P<0.05),术中体动少于P组(P<0.05)。结论DEX用于小儿先心病介入封堵术,具有血流动力学稳定、呼吸抑制轻、术后苏醒快的特点。
Objective To investigate the feasibility and safety of dexmedetomidine (DEX) for sedation in children with CHD. Methods Forty children with stage Ⅰ ~ Ⅱ American Society of Anesthesiologists (ASA) were randomly divided into DEX combined with fentanyl intravenous anesthesia group (D group) and propofol combined Fentanyl intravenous anesthesia group (P group), each group of 20 cases. In group D, the intravenous infusion of DEX at a rate of 1 μg / kg was performed within 10 min, followed by 1 μg / (kg · h) until the end of operation. In group P, the infusion of propofol at a constant rate of 1.5 mg / kg , Followed by 4 ~ 6 mg / (kg · h) until the end of surgery, both groups were given fentanyl 2μg / kg before local anesthesia. The mean arterial pressure (MAP) was recorded before administration (T0), 10 min after administration (T1), at the time of puncture (T2), when the occluder was placed (T3) , Heart rate (HR), respiratory rate (RR) and pulse oxygen saturation (SpO2) were recorded. The bispectral index (BIS) of children was reduced to 70 Time, operation time, recovery time and adverse reactions. Results Compared with T0, the HR of group D was obviously slowed down at T1 ~ T4 (P <0.05). There was no significant difference of MAP and RR between the two groups (P> 0.05) Significantly lower than the P group (P <0.05). The induction time in group D was greater than that in group P (P <0.05), but the recovery time was significantly shorter than that in group P (P <0.05). The body movement in group D was less than that in group P (P <0.05). Conclusion DEX is used in children with congenital heart disease interventional closure, with hemodynamic stability, respiratory depression, rapid recovery after the feature.