预防性使用右美托咪定预防小儿心脏手术后交界性异位性心动过速的疗效
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Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery.
背景与目的
术后交界性异位性心动过速是小儿心脏手术后最严重的心律失常之一，治疗困难，但预防效果良好。目的：评价预防性使用右美托咪定在预防小儿心脏手术后交界性异位性心动过速的疗效。
方 法
对90例因先天性心脏病行择期心脏手术患儿作前瞻性对照研究。将患儿随机分为2组，I组（右美托咪定组）：60例患儿接受右美托咪定干预；II组(安慰剂组)：30例患儿静脉应用等量生理盐水。主要结局指标为术后交界性异位性心动过速的发生率，次要结局指标包括心动过缓、低血压、血管活性肌力评分、通气时间、儿科心脏监护病房留滞时间、住院时间和围手术期死亡率。
结 果
与安慰剂组(16.7%例)相比，右美托咪定组(3.3%例)异位性心动过速发生率明显降低(P<0.005)。右美托咪定组体外循环结束时心率(130.6±9)明显低于安慰剂组(144±7.1)，P<0.001。右美托咪定组的平均通气时间、儿科心脏监护病房平均留滞时间和住院时间(天数)明显短于安慰剂组(p<0.001)。但两组在死亡率、心动过缓、低血压方面无显著差异 (P>0.005)。
结 论
原始文献摘要
El Amrousy D M, Elshmaa N S, El-Kashlan M, et al. Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery:[J]. J Am Heart Assoc, 2017, 6(3).
BACKGROUND:
Postoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery.
METHODS AND RESULTS:
A prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with P<0.005. Heart rate while coming off cardiopulmonary bypass was significantly lower in the dexmedetomidine group (130.6±9) than the placebo group (144±7.1) with P<0.001. Mean ventilation time, and mean duration of intensive care unit and hospital stay (days) were significantly shorter in the dexmedetomidine group than the placebo group (P<0.001). However, there was no significant difference between the 2 groups as regards mortality, bradycardia, or hypotension (P>0.005).
CONCLUSION:
Prophylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects.
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