[1]王 旭,张加强.右美托咪定联合七氟烷在小儿先天性心脏病微创封堵手术中的应用效果[J].新乡医学院学报,2021,38(5):445-448.[doi:10.7683/xxyxyxb.2021.05.010]
 WANG Xu,ZHANG Jiaqiang.Application effect of dexmedetomidine combined with sevoflurane for children with congenital heart disease undergoing minimally invasive closure operation[J].Journal of Xinxiang Medical University,2021,38(5):445-448.[doi:10.7683/xxyxyxb.2021.05.010]
点击复制

右美托咪定联合七氟烷在小儿先天性心脏病微创封堵手术中的应用效果
分享到:

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年5
页码:
445-448
栏目:
临床研究
出版日期:
2021-05-05

文章信息/Info

Title:
Application effect of dexmedetomidine combined with sevoflurane for children with congenital heart disease undergoing minimally invasive closure operation
作者:
王 旭张加强
(河南省人民医院麻醉科,河南 郑州 450003)
Author(s):
WANG XuZHANG Jiaqiang
(Department of Anesthesiology,Henan Provincial People′s Hospital,Zhengzhou 450003,Henan Province,China)
关键词:
右美托咪定七氟烷微创封堵术全凭静脉麻醉
Keywords:
dexmedetomidinesevofluraneminimally invasive closuretotal intravenous anesthesia
分类号:
R614
DOI:
10.7683/xxyxyxb.2021.05.010
文献标志码:
A
摘要:
目的 评价右美托咪定联合七氟烷用于小儿先天性心脏病微创封堵手术的麻醉效果。方法 选择2019年2月至2020年2月于河南省人民医院行经食道超声心动图引导下微创小切口封堵手术的先天性心脏病患儿86例为研究对象。采用随机数字表法将患者分为对照组(n=43)和右美托咪定联合七氟烷组(n=43)。所有患者静脉注射咪达唑仑(0.05~0.10 mg·kg-1)、舒芬太尼(0.50 μg·kg-1)、异丙酚(2.00 mg·kg-1)、顺式阿曲库铵(0.10~0.20 mg·kg-1)进行麻醉诱导。对照组患者静脉输注异丙酚(4~6 mg·kg-1·h-1)、瑞芬太尼(0.1~0.5 μg·kg-1·min-1)进行麻醉维持,右美托咪定联合七氟烷组患者吸入七氟烷(1.0~2.0最低肺泡有效浓度)联合静脉泵入右美托咪定(0.4 μg·kg-1·h-1)进行麻醉维持。记录2组患者麻醉诱导前后及手术前后血压、心率等指标;记录2组患者苏醒时间、拔管时间、恢复室停留时间及苏醒期躁动、呛咳发生情况。结果 右美托咪定联合七氟烷组患者苏醒时间、拔管时间、恢复室停留时间、苏醒期躁动评分均低于对照组(P<0.05);2组患者苏醒期呛咳发生率比较差异无统计学意义(χ2=0.212,P<0.05)。对照组和右美托咪定联合七氟烷组患者麻醉诱导前后及手术前后血压、心率比较差异均无统计学意义(P>0.05)。结论 右美托咪定联合七氟烷麻醉能缩短先天性心脏病患儿微创封堵手术后的苏醒时间、拔管时间及恢复室停留时间,减少麻醉恢复期躁动,改善麻醉效果。
Abstract:
Objective To evaluate the anesthetic effect of dexmedetomidine combined with sevoflurane for children with congenital heart disease undergoing minimally invasive closure operation.Methods  A total of 86 children with congenital heart disease underwent minimally invasive closure operation under transesophageal echocardiography in Henan Provincial People′s Hospital from February 2019 to February 2020 were selected as research objects and were randomly divided into control group (n=43) and dexmedetomidine combined with sevoflurane group(n=43).All patients were given midazolam (0.05-0.10 mg·kg-1),sufentanil (0.50 μg · kg-1),Propofol (2.00 mg · kg-1) and cisatracurium (0.10-0.20 mg · kg-1) for anesthesia induction.The patients in the control group received intravenous infusion of propofol (4-6 mg · kg-1 · h-1) and remifentanil (0.1-0.5 μg · kg-1 · min-1) for anesthesia maintenance,the patients in the dexmedetomidine combined with sevoflurane group received inhalation of sevoflurane (1.0-2.0 minimum alveolar concentration) and intravenous infusion of dexmedetomidine (0.4 μg · kg-1 · h-1) for anesthesia maintenance.The blood pressure and heart rate of patients in the two groups were recorded before and after anesthesia induction and operation;the wake-up time,extubation time,recovery room stay time and occurrence of restlessness and cough during recovery period of patients in the two groups were recorded.Results The wake-up time,extubation time,recovery room stay time and restlessness score during recovery period of patients in the dexmedetomidine combined with sevoflurane group were lower than those in the control group (P<0.05);there was no significant difference in the incidence of cough during recovery period of patients between the two groups(χ2=0.212,P>0.05).There was no significant difference in blood pressure and heart rate of patients between the control group and dexmedetomidine combined with sevoflurane group before and after anesthesia induction and operation (P>0.05).Conclusion The combination of dexmedetomidine and sevoflurane can shorten wake-up time,extubation time,recovery room stay time of congenital heart disease children after undergoing minimally invasive closure operation.It can reduce restlessness of patients during the recovery period of anesthesia and improve the anesthesia effect.

参考文献/References:

[1] WAN L,YU B T,WU Q C,et al.Transthoracic closure of atrial septal defect and ventricular septal defect without cardiopulmonary bypass[J].Genet Mol Res,2015,14 (2):3760-3766.
[2] 新超,柳德斌,王炜.经胸小切口封堵术与外科手术治疗膜部室间隔缺损的对比研究[J].中国心血管病研究杂志,2014,12(4):323-326.
[3] SRIGANESH K,REDDY M,JENA S,et al.A comparative study of dexmedetomidine and propofol as sole sedative agents for patients with aneurysmal subarachnoid hemorrhage undergoing diagnostic cerebral angiography[J].J Anesth,2015,29 (3):409-415.
[4] MALVIYA S,VOEPEL-LEWIS T,RAMAMURTHI R J,et al.Clonidine for the prevention of emergence agitation in young children:efficacy and recovery profile[J].Paediatr Anaesth,2006,16(5):554-559.
[5] 潘湘斌,逄坤静,胡盛寿,等.经食管超声心动图引导下介入治疗房间隔缺损幼儿的有效性和安全性[J].中华心血管病杂志,2013,41(9):744-746.
[6] 林冬生,唐培佳,马媛,等.氯胺酮复合丙泊酚静脉麻醉在小儿先天性心脏病介入封堵术的应用[J].临床麻醉学杂志,2010,26(3):229-230.
[7] 薛晓东,杨改生,夏舒萌,等.瑞芬太尼和丙泊酚靶控输注联合喉罩通气在小儿先天性心脏病介入手术中的应用[J].临床麻醉学杂志,2012,28(10):961-963.
[8] MALLORY M D,BAXTER A L,KOST S I,et al.Propofol vs pentobarbital for sedation of children undergoing magnetic resonance imaging:results from the Pediatric Sedation Research Consortium[J].Paediatr Anaesth,2009,19(6):601-911.
[9] 马媛,唐培佳.舒芬太尼+七氟烷在小儿经胸微创先心封堵术的麻醉效果观察[J].重庆医学,2016,45(15):2125-2127.
[10] 周军,张原源,丛旭晖,等.右美托咪定对全身麻醉扁桃体切除术患儿苏醒期躁动的影响[J].新乡医学院学报,2019,36(4):353-356.
[11] TER BRUGGEN F F J A,ERALP I,JANSEN C K,et al.Efficacy of dexmedetomidine as a sole sedative agent in small diagnostic and therapeutic procedures:a systematic review[J].Pain Pract,2017,17(6):829-840.
[12] 杜立武,董琳,袁亮,等.右美托咪定对七氟烷引起术后躁动的影响[J].临床麻醉学杂志,2012,28(7):718-719.
[13] ISIK B,ARSLAN M,TUNGA A D,et al.Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery[J].Paediatr Anaesth,2006,16(7):748-753.
[14] PICKARD A,DAVIES P,BIRNIE K,et al.Systematic review and meta-analysis of the effect of intraoperative α2-adrenergic agonists on postoperative behaviour in children[J].Br J Anaesth,2014,112(6):982-990.
[15] LIU Y,KANG D L,NA H Y,et al.Consequence of dexmedetomidine on emergence delirium following sevoflurane anesthesia in children with cerebral palsy[J].Int J Clin Exp Med,2015,8 (9):16238-16244.
[16] 刘晴晴,魏碧玉,任鹏,等.右美托咪定防治芬太尼诱导的痛觉过敏的机制研究[J].解放军医学杂志,2018,43(12):1024-1030.
[17] CHENG X,ZUO Y,ZHAO Q,et al.Comparison of the effects of dexmedetomidine and propofol on hemodynamics and oxygen balance in children with complex congenital heart disease undergoing cardiac surgery[J].Congenit Heart Dis,2015,10 (3):E123-E130.
[18] PATEL A,DAVIDSON M,TRAN M C,et al.Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsi-llectomy and adenoidectomy[J].Anesth Analg,2010,111(4):1004-1010.
[19] KIM J,KIM S Y,LEE J H,et al.Low-dose dexmedetomidine reduces emergence agitation after desflurane anaesthesia in children undergoing strabismus surgery[J].Yonsei Med J,2014,55 (2):508-516.

相似文献/References:

[1]解春艳,陈莺,赵振龙,等.七氟烷用于困难气道诱导插管的临床观察[J].新乡医学院学报,2011,(02):196.
[2]杨吉武,唐靖,朱新运,等.右美托咪定对高血压病患者腰硬联合麻醉的镇静效应及血流动力学的影响[J].新乡医学院学报,2012,(05):359.
[3]丁晓英,韩新生,袁浩峥,等.托烷司琼对七氟烷激活小鼠 5- 羟色胺 3 受体的抑制作用[J].新乡医学院学报,2013,(03):185.
[4]贾英萍,李郑琛,邱永升. 右美托咪定滴鼻复合七氟醚吸入麻醉在小儿舌系带成形术中的应用[J].新乡医学院学报,2015,(08):732.
[5]李克寒1,马 丽2,杨惠敏1,等. 右美托咪定对心脏瓣膜置换术患者的脑保护作用[J].新乡医学院学报,2015,(08):762.
[6]吕绪磊,郝建华.剖宫产术中应用右美托咪定对子宫收缩剂不良反应的作用[J].新乡医学院学报,2015,(11):1022.
[7]王晓蕾,郭佳庆,常海宽,等.七氟烷后处理对大鼠心肌缺血再灌注损伤的影响[J].新乡医学院学报,2021,38(11):1006.[doi:10.7683/xxyxyxb.2021.11.002.]
 WANG Xiaolei,GUO Jiaqing,CHANG Haikuan,et al.Effect of sevoflurane post-treatment on myocardial ischemia-reperfusion injury of rats[J].Journal of Xinxiang Medical University,2021,38(5):1006.[doi:10.7683/xxyxyxb.2021.11.002.]
[8]周 军,张原源,丛旭晖,等.右美托咪定对全身麻醉扁桃体切除术患儿苏醒期躁动的影响[J].新乡医学院学报,2019,36(4):353.[doi:10.7683/xxyxyxb.2019.04.013.]
 ZHOU Jun,ZHANG Yuan-yuan,CONG Xu-hui,et al.Effect of dexmedetomidine on agitation during general anesthesia recovery period in children underwent tonsillectomy[J].Journal of Xinxiang Medical University,2019,36(5):353.[doi:10.7683/xxyxyxb.2019.04.013.]
[9]张新科,李保林.不同浓度七氟烷全程吸入对行先天性心脏病矫治术患儿心肌的影响[J].新乡医学院学报,2019,36(7):629.[doi:10.7683/xxyxyxb.2019.07.007.]
 ZHANG Xin-ke,LI Bao-lin.Effect of different concentrations of sevoflurane inhalation on myocardial of children underwent congenital heart disease rectification operation[J].Journal of Xinxiang Medical University,2019,36(5):629.[doi:10.7683/xxyxyxb.2019.07.007.]
[10]杨 燕,张运琼,黄 沾,等.右美托咪定联合舒芬太尼术后镇痛对脊柱手术患者应激反应、炎症反应、氧化应激及免疫功能的影响[J].新乡医学院学报,2020,37(3):277.[doi:10.7683/xxyxyxb.2020.03.019]
 YANG Yan,ZHANG Yunqiong,HUANG Zhan,et al.Effect of dexmedetomidine combined with sufentanil on stress response,inflammatory response and immune function of patients undergoing spinal surgery[J].Journal of Xinxiang Medical University,2020,37(5):277.[doi:10.7683/xxyxyxb.2020.03.019]
[11]陈 奎,禹得水.右美托咪定对老年骨折手术患者全身麻醉苏醒期躁动的影响[J].新乡医学院学报,2017,34(4):294.[doi:10.7683/xxyxyxb.2017.04.012]
 CHEN Kui,YU De-shui.Effect of dexmedetomidine on agitation during general anesthesia recovery period in elderly patients underwent orthopedic surgery[J].Journal of Xinxiang Medical University,2017,34(5):294.[doi:10.7683/xxyxyxb.2017.04.012]

更新日期/Last Update: 2021-05-05