CAJ | 학술논문

目的右美托咪啶(dexmedetomidine,DEX)为α2肾上腺素受体激动剂,目前较多研究正在探索其用于小儿麻醉的可行性.研究比较了DEX与丙泊酚用于小儿心导管术的维持麻醉的药效学.方法选择40例ASA Ⅱ～Ⅲ级、22月～67月、体重11 kg～28 kg导管介入治疗患儿,进入导管室后静注氯胺酮2 mg/kg,咪达唑仑0.1 ms/ks,长托宁0.05 mg/kg.按抽签的方法随机分为2组(每组20例):D组10min内静脉输注负荷量DEX0.8 μg/kg,随后以1μg·kg-1·h-1连续输注;P组10 min内静脉输注负荷量丙泊酚1.5 mg/kg,随后以3 mg·kg-1·h-1连续输注.术中根据调节DEX或丙泊酚输注速度,维持脑电双频指数值在55～65.麻醉前、麻醉后10 min和40 min记录循环、呼吸指标并观察回病房后镇静药需求.结果麻醉后40 min,D组心率(HR)(117±10)次份显著低于P组(126±9)次/分(P<0.05);麻醉后两组呼气末二氧化碳分压(end-tidal pressure of carbon dioxide,PETCO2)均较基础值轻微升高,但差异无统计学意义(P>0.05).P组需镇静治疗的患儿(12例)显著多于D组(P<0.05).结论 DEX和丙泊酚均可为小儿心导管介入提供充分的麻醉.相比丙泊酚,患儿HR减慢,但术后躁动较少.
목적 우미탁미정(dexmedetomidine,DEX)위α2신상선소수체격동제,목전교다연구정재탐색기용우소인마취적가행성.연구비교료DEX여병박분용우소인심도관술적유지마취적약효학.방법 선택40례ASA Ⅱ～Ⅲ급、22월～67월、체중11 kg～28 kg도관개입치료환인,진입도관실후정주록알동2 mg/kg,미체서륜0.1 ms/ks,장탁저0.05 mg/kg.안추첨적방법 수궤분위2조(매조20례):D조10min내정맥수주부하량DEX0.8 μg/kg,수후이1μg·kg-1·h-1련속수주;P조10 min내정맥수주부하량병박분1.5 mg/kg,수후이3 mg·kg-1·h-1련속수주.술중근거조절DEX혹병박분수주속도,유지뇌전쌍빈지수치재55～65.마취전、마취후10 min화40 min기록순배、호흡지표병관찰회병방후진정약수구.결과 마취후40 min,D조심솔(HR)(117±10)차빈현저저우P조(126±9)차/분(P<0.05);마취후량조호기말이양화탄분압(end-tidal pressure of carbon dioxide,PETCO2)균교기출치경미승고,단차이무통계학의의(P>0.05).P조수진정치료적환인(12례)현저다우D조(P<0.05).결론 DEX화병박분균가위소인심도관개입제공충분적마취.상비병박분,환인HR감만,단술후조동교소.
Objective Dexmedetomidine(DEX) is α2 agonist currently being investigated for its application in anesthesia for children. Pharmacodynamic responses to DEX and propofol in children anesthetized undergoing cardiac catheterization were compared. Methods Forty children( 22 kg～67 kg months old, 11 kg～28 kg) were randomized to receive either propofol (group P) or DEX (group D) for anesthesia maintenance for elective cardiac catheterization. All patients received ketamine 2 mg/kg, midazolam 0.1 mg/kg and penehyclidine hydrochloride 0.05 mg/kg intravenously after arriving at the cardiac catheterization room. DEX was administered at an initial loading dose (0.8 g/kg for 10 min) followed by a continuous infusion (1 μg·kg-1·h-1) in group D. Propofol was administered at a bolus dose (1.5 mg·kg-1h-1 for 10 min) followed by a continuous infusion(3 mg·kg-1·h-1). The infusion rates of DEX or propofol were adjusted to maintain BIS 55 to 65 during the operation. Vital signs, PETCO2 and supplemental sedatives were monitored and documented. Results Heart rate was significantly slower in group D (117±10) bpm than in group P (126±9) bpm 40 min after DEX or propofol administration (P<0.05). There was no significant difference in PETCO2 between two groups. Requirement of supplemental sedatives was less in group D than in group P (12 cases) (P<0.05). Conclusion DEX provides adequate anesthesia for cardiac catheterization. Compared with propofol, DEX led to lower heart rate and less agitation after catheterization.