Effect of dexmedetomidine on perioperative hemodynamics and organ protection in children with congenital heart disease: A randomized controlled trial.
Effect of dexmedetomidine on perioperative hemodynamics and organ protection in children with congenital heart disease: A randomized controlled trial.
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DOI：
10.1097/md.0000000000023998
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发表时间：
2021-01-08
期刊：
影响因子：
1.6
通讯作者：
Xie Y
中科院分区：
文献类型：
--
作者：
Ming S;Xie Y;Du X;Huang H;Fan Y;Liang Q;Xie Y
本研究旨在探讨右美托咪定（Dex）对先天性心脏病（CHD）患儿低温体外循环心内直视手术血流动力学和器官保护的影响。将90名儿童随机分配至C组（0.9%生理盐水0.2 μg/kg/h）、D1组（Dex 0.2 μg/kg/h）和D2组（Dex 0.4 μg/kg/h）（每组n=30）。 所有参与者均接受芬太尼、丙泊酚和1%七氟醚进行麻醉诱导。从T0（诱导前）至T7（拔管后30分钟）测量血流动力学数据。根据Fick公式计算动脉颈内静脉球氧差和脑氧摄取率。采用酶联免疫吸附法检测血清心肌、脑、肾损伤标志物。根据血清肌酐水平计算急性肾损伤（阿基）发生率。记录拔管时间、术后疼痛评分和苏醒期躁动评分。与C组相比，D1、D2组血流动力学参数、心肌和脑损伤指标、气管拔管时间明显缩短。3组之间的血尿素氮和中性粒细胞明胶酶相关脂质运载蛋白或阿基发生率无显着差异。D1、D2组心动过速、恶心、呕吐、中度躁动发生率及FLACC评分均低于C组。Dex 0.4 g/kg/h组较Dex 0.2 g/kg/h组芬太尼和多巴胺用量进一步减少。 地塞米松麻醉能有效维持CHD患儿血流动力学稳定，减少脏器损伤。
This study aimed to investigate the effects of dexmedetomidine (Dex) on hemodynamics and organ protection in congenital heart disease (CHD) children who underwent open-heart surgery under cryogenic cardiopulmonary bypass. Ninety children were randomly allocated to group C (0.9% saline 0.2 μg/kg/hour), group D1 (Dex 0.2 μg/kg/hour), and group D2 (Dex 0.4 μg/kg/hour) (n = 30 per group). All participants received fentanyl, propofol and 1% sevoflurane for anesthesia induction. Hemodynamic data were measured from T0 (before the induction) to T7 (30 minutes after extubation). The difference of arterial internal jugular vein bulbar oxygen difference and cerebral oxygen extraction ratio were calculated according to Fick formula. Enzyme-linked immunosorbent assay was performed to detect the serum myocardial, brain and kidney injury markers. The incidence of acute kidney injury (AKI) was calculated by serum creatinine level. Tracheal extubation time, postoperative pain score and emergence agitation score were also recorded. Compared with group C, group D1, and D2 exhibited reduction in hemodynamic parameters, myocardial and brain injury indicators, and tracheal extubation time. There were no significant differences in blood urea nitrogen and neutrophil gelatinase-associated lipocalin or incidence of AKI among the 3 groups. Besides, the incidence of tachycardia, nausea, vomiting and moderate agitation, and the FLACC scale in group D1 and D2 were lower than those in group C. Moreover, Dex 0.4 g/kg/hour could further reduce the dosage of fentanyl and dopamine compared with Dex 0.2 g/kg/hour. Dex anesthesia can effectively maintain hemodynamic stability and diminish organ injuries in CHD children.