国际麻醉学与复苏杂志   2011, Issue (3): 0-0
    
右美托咪啶与异丙酚用于小儿心导管术麻醉的比较
陈怡绮, 白洁, 李波, 王燕婷, 张马忠1()
1.上海交通大学医学院附属上海儿童医学中心
A Comparison of Dexmedetomidine with Propofol for Anesthesia in Children undergoing Cardiac Catheterization
 全文:
摘要:

【摘要】 目的 探索并比较右美托咪啶与异丙酚用于小儿心导管术的可行性与安全性。方法 40例22-67Mon、体重11-28kg因动脉导管未闭、房缺或室缺行导管介入治疗的患儿。进入导管室后静注氯胺酮2mgkg-1,咪唑安定0.1mgkg-1,长托宁0.05mgkg-1。随机分为两组:D组静脉输注负荷量右美托咪啶0.8μgkg-1,随后以1μgkg-1h-1连续输注;P组静脉输注负荷量异丙酚1.5mgkg-1,随后以3mgkg-1h-1连续输注。负荷量在10min内给完。麻醉前、麻醉后10min和40min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40min,D组心率11710次min-1较基础值下降且D组显著低于P组(P<0.05);麻醉后10min两组PETCO2均较基础值显著升高,麻醉后P组PETCO2均显著高于D组(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 右美托咪啶和异丙酚均可安全有效地用于小儿心导管介入麻醉,但在减少呼吸抑制和术后躁动方面,右美托咪啶较异丙酚可能有一定优势。

关键词: 右美托咪啶;异丙酚;先心病;麻醉;心导管术
Abstract:

[Abstract]Objective Dexmedetomidine is investigated for its efficacy and safety to provide maintenance of anesthesia for children. We compared the pharmacodynamic responses to dexmedetomidine and propofol undergoing cardiac catheterization. Methods 40 pediatric patients, aged 22-67month, weighted 11-28kg, scheduled for elective cardiac catheterization for therapy of PDA, ASD, and VSD were randomly divided into group P and D. All patients received ketamine 2mg•kg-1, midazolam 0.1mg•kg-1 and penehyclidine hydrochloride 0.05mg•kg-1 intravenously after arriving at the cardiac catheterization laboratory. The patients in group D received dexmedetomidine bolus 0.8μg•kg-1 for 10 min and followed by 1μg•kg-1•h-1. The patients in group P received propofol bolus 1.5mg•kg-1 for 10 min and followed by 3 mg•kg-1•h-1. Vital signs, PETCO2 and supplemental sedatives were monitored and documented. Results Heart rate 117±10bpm decreased significantly in group D at 40 min postanesthesia compared with the baseline and that of group P (P<0.05). PETCO2 at 10min postanesthesia increased significantly compared with baseline in both groups (P<0.05). PETCO2 of group P at 10, 40 min were greater than that of group D (P<0.05). There were more patients (12 patients) in group P required supplemental sedatives postoperatively (P<0.05). Conclusions Dexmedetomidine can provide adequate anesthesia for cardiac catheterization. Heart rate was slower and PETCO2 was less with dexmedetomidine when compared with propofol.

Key words: dexmedetomidine, propofol, congenital heart disease, anesthesia, cardiac catheterization