国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2014年
2期
124-126
,共3页
术后镇痛%镇静%心脏手术%小儿%右美托咪定
術後鎮痛%鎮靜%心髒手術%小兒%右美託咪定
술후진통%진정%심장수술%소인%우미탁미정
Postoperative analgesia%Sedative%Cadiac surgery%Pediatrics%Dexmedetomidine
目的 观察右美托咪定(dexmedetomidine,Dex)用于小儿心脏手术后镇静镇痛的可行性和效果.方法 择期行房间隔缺损修补或室间隔缺损修补手术的小儿患者40例,1岁～7岁,体重8 kg～25 kg,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,采用随机数字表法分为Dex组(D组)和对照组(N组),每组20例.D组于手术结束缝皮前经静脉持续注射Dex 0.3 μg·kg-1·h-1,持续至术后24h.N组静脉持续注射等剂量生理盐水.观察术后4、8、12、16、24 h患者的FLACC评分和Ramsay评分.当FLACC评分＞6分或Ramsay评分为1分时,静脉给予咪达唑仑0.1 mg/kg.记录术后24h两组患者咪达唑仑使用次数和使用量,并观察术后有无呼吸抑制、心动过缓等并发症.结果 在术后8、12、16、24 h FLACC评分D组(2,2,2,3)(中位数)低于N组(5,5,6,5),Ramsay评分D组(3,2,2,2)高于N组(2,1,1,1),术后24h咪达唑仑使用次数和使用量D组(0次,0 mg/kg)也少于N组(3次,0.3 mg/kg)(中位数),差异有统计学意义(P＜0.05).两组患者术后均未见相关并发症.结论 小儿心脏手术后使用0.3 μg· kg-1·h-1Dex可在术后早期提供良好镇静、镇痛作用,且无其他副作用.
目的 觀察右美託咪定(dexmedetomidine,Dex)用于小兒心髒手術後鎮靜鎮痛的可行性和效果.方法 擇期行房間隔缺損脩補或室間隔缺損脩補手術的小兒患者40例,1歲～7歲,體重8 kg～25 kg,美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級,採用隨機數字錶法分為Dex組(D組)和對照組(N組),每組20例.D組于手術結束縫皮前經靜脈持續註射Dex 0.3 μg·kg-1·h-1,持續至術後24h.N組靜脈持續註射等劑量生理鹽水.觀察術後4、8、12、16、24 h患者的FLACC評分和Ramsay評分.噹FLACC評分＞6分或Ramsay評分為1分時,靜脈給予咪達唑崙0.1 mg/kg.記錄術後24h兩組患者咪達唑崙使用次數和使用量,併觀察術後有無呼吸抑製、心動過緩等併髮癥.結果 在術後8、12、16、24 h FLACC評分D組(2,2,2,3)(中位數)低于N組(5,5,6,5),Ramsay評分D組(3,2,2,2)高于N組(2,1,1,1),術後24h咪達唑崙使用次數和使用量D組(0次,0 mg/kg)也少于N組(3次,0.3 mg/kg)(中位數),差異有統計學意義(P＜0.05).兩組患者術後均未見相關併髮癥.結論 小兒心髒手術後使用0.3 μg· kg-1·h-1Dex可在術後早期提供良好鎮靜、鎮痛作用,且無其他副作用.
목적 관찰우미탁미정(dexmedetomidine,Dex)용우소인심장수술후진정진통적가행성화효과.방법 택기행방간격결손수보혹실간격결손수보수술적소인환자40례,1세～7세,체중8 kg～25 kg,미국마취의사협회(ASA)분급Ⅰ～Ⅱ급,채용수궤수자표법분위Dex조(D조)화대조조(N조),매조20례.D조우수술결속봉피전경정맥지속주사Dex 0.3 μg·kg-1·h-1,지속지술후24h.N조정맥지속주사등제량생리염수.관찰술후4、8、12、16、24 h환자적FLACC평분화Ramsay평분.당FLACC평분＞6분혹Ramsay평분위1분시,정맥급여미체서륜0.1 mg/kg.기록술후24h량조환자미체서륜사용차수화사용량,병관찰술후유무호흡억제、심동과완등병발증.결과 재술후8、12、16、24 h FLACC평분D조(2,2,2,3)(중위수)저우N조(5,5,6,5),Ramsay평분D조(3,2,2,2)고우N조(2,1,1,1),술후24h미체서륜사용차수화사용량D조(0차,0 mg/kg)야소우N조(3차,0.3 mg/kg)(중위수),차이유통계학의의(P＜0.05).량조환자술후균미견상관병발증.결론 소인심장수술후사용0.3 μg· kg-1·h-1Dex가재술후조기제공량호진정、진통작용,차무기타부작용.
Objective To observe the feasibility and effect of the postoperative use of dexmedetomidine (Dex) on postoperative sedation and analgesia in pediatric patients undergoing cardiac surgery.Methods Forty pediatric patients undergoing elective atrial septum defect repair or ventricular septal defect repair surgery,aged 1-7 years old,with body weight 8 kg-25 kg and ASA Ⅰ-Ⅱ level,were enrolled,and randomly divided into two groups,the experimental group and the control group,20 cases in each group.The patients assigned to experimental group received a continuous infusion of Dex,dose of 0.3 μg·kg-1 ·h-1,starting at the beginning of seam the skin and continuing for 24 h postoperation,and isodose normal sodium as placebo was infused to the control group patients.The FLACC scores and the Ramsay scores were recorded at 4,8,12,16,24 h postoperatively by a nurse blind to the grouping.Once the FLACC score was over 6 or the Ramsay scores reach to 1,midazolam 0.1 mg/kg was injected intravenously.The mean artery pressure and heart rate were recorded at the corresponding time points.The dose and times of midazolam use were recorded.Postoperative complications,such as respiratory depression and bradycardia,were observed during the first 24 h after surgery.Results Compared with the control group,the FLACC scores were lower [(2,2,2,3) vs (5,5,6,5)] and the Ramsay scores were higher [(3,2,2,2) vs (2,1,1,1)] in the experimental group at the 8,12,16,24 h postoperatively (median,experimental vs control,P＜0.05),and the times and doses of midazolam use throughout 24 h were lower respectively (median,experimental vs control:times:0 vs 3,doses:0 mg/kg vs 0.3 mg/kg,P＜0.05).Neither postoperative respiratory depression nor bradycardia was identified.Conclusions Continuous infusion of Dex with a dose of 0.3 μg·kg-1 ·h-1 may provide good postoperative pain relief and sedation in pediatric patients undergoing cardiac surgery.No adverse effects were observed.
