右美托咪定对全身麻醉患儿血糖和血钾水平的影响
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Effects of Dexmedetomidine on Blood Glucose and Serum Potassium Levels in Children Undergoing General Anesthesia: A Secondary Analysis of Safety Endpoints During a Randomized Controlled Trial
背景与目的
右美托咪定是一种高选择性α2肾上腺素能激动剂，在小儿麻醉和重症监护中的应用日益广泛。然而，其潜在不良反应尚未在儿童中进行严格评估，包括右美托咪定对与不良结局相关的血糖和血清钾浓度的影响。本研究旨在探讨三种不同剂量的右美托咪定对择期手术儿童血糖和血钾浓度的影响。
方 法
选择64名ASAI–II级3至10岁儿童随机接受麻醉诱导后60s内静脉推注右美托咪定0.25μg/ kg、 0.5μg/ kg、0.75μg/ kg或0μg/ kg（对照组）。分别在给药前和给药后15、30分钟测定静脉血中葡萄糖和钾浓度的变化。在组内和组间绘制数据图，并使用约束性纵向数据方法进行分析。
结 果
49名患儿完成了这项研究。与基线水平相比，15分钟和30分钟时平均血糖水平升高，分别为0.37 mmol/L（95%CI，0.29–0.45 mmol/L）和0.05 mmol/L（95%CI，0.00–0.10 mmol/L）；在15分钟时，存在剂量-反应关系（1.07 mmol/L/μg/kg[95%CI，0.57–1.58 mmol/L/μg/kg]），但在30分钟时，没有此效应（0.15 mmol/L/μg/kg[95%CI，-0.40–0.70 mmol/L/μg/kg]）；钾水平相对于基线下降，在15分钟时的平均差为-0.20 mEq / L（95％CI，-0.28至-0.12 mEq / L）和在30分钟时的平均差为-0.12 mEq / L（95％CI， -0.15至-0.08 mEq / L），但在任何时间点，右美托咪定均无明显作用。
结 论
儿童麻醉诱导后，血糖小幅度升高且钾水平减少。15分钟时血糖升高与右美托咪定呈剂量相关性。
原始文献摘要
Effects of Dexmedetomidine on Blood Glucose and Serum Potassium Levels in Children Undergoing General Anesthesia: A Secondary Analysis of Safety Endpoints During a Randomized Controlled Trial [J]. Anesthesia & Analgesia, 2019 Oct;129(4):1093-1099.
BACKGROUND: Dexmedetomidine is a highly selective α2-adrenergic agonist, which is increasingly used in pediatric anesthesia and intensive care. Potential adverse effects that have not been rigorously evaluated in children include its effects on blood glucose and serum potassium concentrations, which are relevant due to the associations of derangements of both parameters with undesired outcomes. We investigated the effects of 3 different doses of dexmedetomidine on these outcomes in a randomized controlled trial in children undergoing elective surgery.
METHODS: Sixty-four American Society of Anesthesiologists I–II children were randomized to receive either dexmedetomidine 0.25 µg/kg, dexmedetomidine 0.5 µg/kg, dexmedetomidine 0.75 µg/kg, or 0 µg/kg (control), as a bolus administered over 60 seconds after induction of anesthesia. Changes in plasma glucose and serum potassium concentrations were measured in venous blood sampled before and at 15 and 30 minutes after study drug administration. Data were plotted within and between groups and analyzed using a constrained longitudinal data approach.
RESULTS: Forty-nine children completed the study. Mean glucose levels at 15 and 30 minutes were elevated with estimated changes from baseline of 0.37 mmol/L (95% CI, 0.29–0.45 mmol/L) and 0.05 mmol/L (95% CI, 0.00–0.10 mmol/L), respectively. At 15 minutes, there was a linear dose–response relationship (1.07 mmol/L/μg/kg [95% CI, 0.57–1.58 mmol/L/μg/kg]), but there was no appreciable effect of dexmedetomidine at 30 minutes (0.15 mmol/L/μg/kg [95% CI, −0.40 to 0.70 mmol/L/μg/kg]). Potassium levels were depressed relative to baseline, with a mean difference at 15 minutes of −0.20 mEq/L (95% CI, −0.28 to −0.12 mEq/L) and
at 30 minutes of −0.12 mEq/L (95% CI, −0.15 to −0.08 mEq/L), but there was no appreciable effect of dexmedetomidine at either time.
CONCLUSIONS: Small elevations in glucose and decreases in potassium were observed after induction of anesthesia in children. The elevation in glucose at 15 minutes depended on the dose of dexmedetomidine administered. These preliminary data warrant further investigation.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：王贵龙 编辑：何幼芹 审校：王贵龙