Dexmedetomidine is Associated with an Increased Incidence of Bradycardia in Patients with Trisomy 21 After Surgery for Congenital Heart Disease
Dexmedetomidine is Associated with an Increased Incidence of Bradycardia in Patients with Trisomy 21 After Surgery for Congenital Heart Disease
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DOI：
10.1007/s00246-016-1421-8
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发表时间：
2016-10-01
影响因子：
1.6
通讯作者：
Kawano, Yoshifumi
中科院分区：
文献类型：
--
作者：
Ueno, Kentaro;Ninomiya, Yumiko;Kawano, Yoshifumi
本研究旨在评价21三体婴儿和无21三体婴儿（对照组）使用右美托咪定的不良心脏事件，并检查心血管手术后婴儿的潜在风险因素。我们进行了一项单中心回顾性队列研究。纳入了2013年4月1日至2015年10月31日期间接受心血管手术的124名连续婴儿的病历。分析了临床特征、右美托咪定的使用和围手术期用药。采用Naranjo评分和世界卫生组织乌普萨拉监测中心（WHO-UMC）标准评估不良心脏事件。总共有124名连续婴儿（30名患者和94名对照）符合入选标准。30名21三体患者中有8名（26. 7%）和94名对照中有12名（12. 8%）经历了不良心脏事件（即，右美托咪定治疗期间的低血压、一过性高血压和心动过缓），中位Naranjo评分为6，WHO-UMC标准的因果关系类别为“肯定”或“很可能”。其中，21三体患者的心动过缓发生率高于对照组（P = 0.011）。多元logistic回归分析显示，21三体的存在是心血管手术后右美托咪定不良心脏事件的独立危险因素（比值比4.10，95%CI 1.17-11.19，P = 0.006）。右美托咪定与先天性心脏病手术后21三体患者心动过缓发生率增加相关。使用右美托咪定的医生应充分了解21三体患者的特点，并密切观察血流动力学监测。
This study aimed to evaluate adverse cardiac events using dexmedetomidine in infants with trisomy 21 and those without (controls) and examined potential risk factors in infants after cardiovascular surgery. We conducted a single-center retrospective cohort study. The medical records of 124 consecutive infants who had undergone cardiovascular surgery between April 1, 2013, and October 31, 2015, were enrolled. Clinical characteristics, usage of dexmedetomidine, and perioperative medications were analyzed. Adverse cardiac events were assessed with the Naranjo score and World Health Organization-The Uppsala Monitoring Centre (WHO-UMC) criteria. In total, 124 consecutive infants (30 patients and 94 controls) met the inclusion criteria. Eight of 30 (26.7 %) patients with trisomy 21 and 12 of 94 (12.8 %) controls experienced adverse cardiac events (i.e., hypotension, transient hypertension, and bradycardia) during dexmedetomidine with median Naranjo score of 6, and causality categories of WHO-UMC criteria were "certain" or "probable." Of those, the incidence of bradycardia occurred at a higher rate in patients with trisomy 21 than in controls (P = 0.011). Multiple logistic regression analysis revealed that the presence of trisomy 21 was an independent risk factor for adverse cardiac events of dexmedetomidine after cardiovascular surgery (odds ratio 4.10, 95 % CI 1.17-11.19, P = 0.006). Dexmedetomidine is associated with an increased incidence of bradycardia in patients with trisomy 21 after surgery for congenital heart disease. Physicians using dexmedetomidine should know a great deal about the characteristics of patients with trisomy 21, and hemodynamic monitoring should be closely observed.