右美托咪定复合芬太尼对小儿心脏手术血压及心率的影响

摘要

目的：探讨右美托咪定复合芬太尼对小儿心脏手术血压及心率的影响。方法选择2011年2月至2014年12月石家庄市第四医院收治的30例行体外循环下先天性心脏病修补的患儿作为研究对象，依据随机数字表法分为对照组和研究组，各15例。第1小时，对照组患儿给予0.2 mg／（kg· h）咪达唑仑，研究组患儿给予1μg／（kg· h）右美托咪定，待2 h后，两组患儿的药物输注剂量均减少一半。所有患儿的麻醉诱导第1小时均给予10μg／kg 芬太尼、0.2 mg／kg 维库溴铵以及0.2 mg／kg咪达唑仑。1 h后维库溴铵、芬太尼药物用量均减少一半，一直持续到手术结束。为达到控制血流动力学反应的目的，切皮手术或切胸骨手术等具有强烈性刺激时给予患儿吸入七氟烷。比较两组患儿治疗过程中心率、平均动脉压（ MAP）、脉搏血氧饱和度（ SpO2）的变化。结果对照组患儿的心率在T1时上升，T2时下降，T3时又上升，研究组心率平稳，T1、T2、T3优于对照组[（88.4±9.6）次／min比（98.3±9.7）次／min，（85.4±10.4）次／min比（97.7±11.2）次／min，（90.5±9.9）次／min比（127.3±12.9）次／min]，两组间、时点间、组间·时点间交互效应差异有统计学意义（P＜0.05）。对照组患儿的MAP在T1、T2、T3时间点呈上升趋势，研究组 T1、T2时较平稳，T3时升高，且研究组T1、T2、T3时间点的 MAP 均低于对照组[（73.1±6.9） mmHg 比（83.7±6.5） mmHg，（72.3±7.5） mmHg 比（84.8±6.9） mmHg，（79.3±6.4） mmHg比（100.6±9.9） mmHg]，两组间、时间点、组间·时间点交互效应比较差异有统计学意义（ P＜0.05）。对照组在 T1、T2、T3时间点的 SpO2呈上升趋势，研究组与对照组比较各时间点波动较小[（98.3±0.8）％比（93.5±0.5）％，（97.4±1.2）％比（95.1±0.9）％，（97.8±1.4）％比（96.3±1.2）％]，研究组 T1、T2、T3时间点 SpO2高于对照组，两组间、时间点、组间·时间点交互效应比较差异有统计学意义（ P＜0.05）。结论在进行儿童先天性心脏病手术前，可对患儿输注右美托咪定复合芬太尼进行麻醉，可更好地控制患儿血流动力学反应状况，具有较大临床应用价值，值得大力推广应用。%Objective To analyze the effect of dexmedetomidine combined with fentanyl on the blood pressure and heart rate in pediatric cardiac surgery.Methods Total of 30 children with congenital heart dis-ease undergoing cardiac repair with cardiopulmonary bypass in Shijiazhuang Fourth Hospital from Feb . 2011 to Dec.2014 were included in the study,and divided into a control group(15 cases) and a study group (15 cases) according to the random number table method.After the first hour,the control group was given 0.2 mg/(kg· h) midazolam,while the study group was given l μg/( kg· h) dexmedetomidine,after two hours,the drug infusion doses of both groups were reduced by half.All patients were given anesthesia induc-tion of 10 μg/kg fentanyl,0.2 mg/kg vecuronium and 0.2 mg/kg midazolam in the first hour.1 hour later, vecuronium and fentanyl dosage was reduced by half,until the end of operation.In order to control the hemo-dynamic responses to cut,sevoflurane inhalation was given during intense stimulations such as skin cut and breastbone cut.The heart rate(HR),mean arterial pressure(MAP),oxygen saturation of pulse (SpO2) changes of the two groups during treatment were compared.Results The HR increased at T1 and decreased at T2,then increased again at T3 in the control group,while stable heart rate was observed in the study group, better than the control group at T1,T2,T3[(88.4 ±9.6) times/min vs (98.3 ±9.7) times/min,(85.4 ± 10.4) times/min vs (97.7 ±11.2) times/min,(90.5 ±9.9) times/min vs (127.3 ±12.9) times/min], the differences were statistically significant(P<0.05).The MAP of the control group at T1,T2 and T3 time points showed an upward trend,of the study group were relatively stable at T1 and T2 ,increased at T3 ,and the study group at T1 , T2 and T3 were lower than the control group [ ( 73.1 ±6.9 ) mmHg vs ( 83.7 ± 6.5) mmHg,( 72.3 ±7.5) mmHg (84.8 ±6.9) mmHg,(79.3 ±6.4) mmHg vs (100.6 ±9.9) mmHg], the differences between the two groups,time points,and groups time points interaction were statistically sig-nificant(P<0.05).SpO2 of the control group at T1,T2 and T3 time points showed an upward trend,while the study group showed relatively small fluctuationsat different time points [ ( 98.3 ±0.8 )% vs ( 93.5 ± 0.5)%,(97.4 ±1.2)% vs (95.1 ±0.9)%,(97.8 ±1.4)% vs (96.3 ±1.2)%],SpO2 of the study group at T1 ,T2 ,T3 was higher than the control group,the differences between the two groups,time points, groups· time points interaction were statistically significant ( P <0.05 ) .Conclusion Before surgery for children with congenital heart disease, dexmedetomidine combined with fentanyl can be administered for anesthesia,which can better control hemodynamic response and has great clinical applicative value,thus is worthy of extensive popularizing.