体外循环心脏手术后患儿应用右美托咪定镇静拔除气管插管的效果观察

Effect of dexmedetomidine on extubation after cardiopulmonary bypass cardiac surgery in pediatric patients

  • 摘要: 目的 观察体外循环心脏手术后患儿应用右美托咪定镇静拔除气管插管的效果。 方法 选择2013年5月-2015年4月在我院行体外循环下心脏手术患儿127例,根据患儿拔管期间是否使用右美托咪定分为两组,观察组(74例)手术后使用右美托咪定镇静下拔除气管插管,对照组(53例)常规拔除气管插管。观察两组拔管前、拔管时及拔管后10 min的心率、平均动脉压及呼吸频率;同时观察两组拔管前躁动评估、再次应用镇静药物情况、拔管时间及带气管插管时间。 结果 两组患儿计划拔管时心率(92.6±15.31)/min vs (91.72±16.52)/min、平均动脉压(68.52±6.43) mmHg vs (69.23±7.12) mmHg(1 mmHg=0.133 kPa)及呼吸频率(23.83±3.34)次/min vs (24.17±3.52)次/min差异无统计学意义(P> 0.05);观察组与对照组患儿拔管前及拔管后的心率(94.32±14.23)/min vs (109.40±24.78)/min;(95.52±15.48)/min vs (104.62±23.37)/min、平均动脉压(67.47±5.69) mmHg vs (76.84±9.78) mmHg;(68.45±6.14) mmHg vs (74.19±8.67) mmHg及呼吸频率(24.25±3.86) 次/min vs (27.36±5.48)次/min;(23.94±4.15)次/min vs (26.53±6.27)次/min,组间比较差异均有统计学意义(P< 0.05);观察组与对照组患儿拔管前镇静躁动Riker评分(2.81±0.24 vs 3.92±0.53)及再次应用镇静药物率(6.75% vs 39.62%)差异有统计学意义(P< 0.05);观察组与对照组患儿拔管时间(47.32±11.24) min vs (58.46±25.03) min及带气管插管时间(5.12±1.05) h vs (6.73±1.87) h差异有统计学意义(P< 0.05)。 结论 体外循环心脏手术患儿术后应用右美托咪定镇静下拔管有利于血流动力学的稳定,并可以减少拔管期躁动及镇静药物再次使用,有效缩短了拔管时间及带气管插管时间。

     

    Abstract: Objective To observe the sedative effect of dexmedetomidine on pediatriac patients when extubating after cardiopulmonary bypass cardiac surgery. Methods From May 2013 to April 2015, a total of 127 pediatric patients were enrolled in this study.The patients were divided into two groups according to whether sedation with dexmedetomedine was lasted over extubation.Dexmedetomedine was continuously administered over the extubation period in observation group (n=74), and the patients were extubated without sedation in control group (n=53).The heart rate, mean arterial pressure and respiratory rate before, during and 10 min after extubation were recorded.Score of agitation scale before extubation, re-administration of sedative medication, duration of extubation time and intubation duration were also collected. Results There was no significant difference in heart rate (92.6±15.31) /min vs (91.72±16.52) /min, mean arterial pressure (68.52±6.43) mmHg vs (69.23±7.12) mmHg and respiratory rate (23.83±3.34) /min vs (24.17±3.52) /min during extubation between two groups (P> 0.05).The heart rate (94.32±14.23) /min vs (109.40±24.78) /min, (95.52±15.48) /min vs (104.62±23.37) /min, mean arterial pressure (67.47±5.69) mmHg vs (76.84±9.78) mmHg, (68.45±6.14) mmHg vs (74.19±8.67) mmHg and respiratory rate (24.25±3.86)/ min vs (27.36±5.48) /min, (23.94±4.15) /min vs (26.53±6.27) /min before and after extubation in observation group were significantly lower than control group (P< 0.05).The Agitation Ricker score (2.81±0.24) vs (3.92±0.53) and the incidence of re-administration of sedative medication (6.75% vs 39.62%) in observation group were significantly lower than control group (P< 0.05).The extubation time (47.32±11.24) min vs (58.46±25.03) min and intubation period (5.12±1.05) h vs (6.73±1.87) h in observation group were significantly lower than control group (P< 0.05). Conclusion Administration of dexmedetomedine over extubation after cardiac surgery with cardiopulmonary bypass can maintain steady hemodynamics, reduce agitation and avoid readministration of sedative medication in children, which will shorten the extubation time and intubation period effectively.

     

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