右美托咪定对心脏手术麻醉诱导期间血流动力学的影响

目的重点研究和探讨右美托咪定对心脏手术的麻醉效果以及麻醉诱导期间血流动力学的影响。方法利用回顾性分析的方法研究和比较对我院于2010年1月1日-2013年11月31日期间收治的114例行心脏手术麻醉患者的临床资料进行回顾性对照分析。将患者随机分为2组,均给予常规静脉麻醉,观察组总计57例在常规静脉麻醉的基础上静脉注射右美托咪定;对照组总计57例在常规静脉麻醉的基础上静脉注射与观察组等量的生理盐水。然后将2组数据结果进行分析,分析探讨两组患者麻醉效果以及麻醉诱导期间血流动力学的影响。结果通过对我院收治的114例行心脏手术麻醉患者的临床资料进行分析,两组患者在注药后5min时MAP值均明显下降,对照组下降幅度更大(P0.05),在注药后10min、15min和30min时MAP值与基础值相比略有下降,但差异无显著性;对照组在注药后5min的HR值比基础值明显增快(P0.05);SPO2两组差异无显著性(P0.05)。观察组患者术后疼痛评分、清醒时间、呼吸恢复时间、阻滞完全时间、定向力恢复时间均好于对照组患者(P0.05)。结论右美托咪定对心脏手术患者具有很好的麻醉效果,并且能够平稳血流动力学相关指标,目前已经成为行心脏手术静脉麻醉患者的主要药物,值得临床借鉴和进一步推广。     

高龄患者应用右美托咪定麻醉的效果

<正>随着社会老龄化的日益加重,高龄患者的手术麻醉日趋增多。由于高龄患者对麻醉耐受差,术中血流动力学波动大,术后苏醒延迟,谵妄发生率高。针对老年患者的特点,我院采用具有镇静催眠、抗焦虑、镇痛作用,又能抑制交感神经活性、改善手术期间的心血管稳定性的α2肾上腺素能受体(α2AR)激动药右美托咪定(Dex)静脉麻醉〔1,2〕,取得满意效果。     

右美托咪定对小儿先天性心脏病术后急性肾功能损伤的预防效应

目的 了解右美托咪定对小儿先天性心脏病术后急性肾功能损伤的预防效应。 方法 30例确诊房间隔或室间隔缺损的患儿参与研究。患儿随机分别接受生理盐水(对照组，n = 15)和右美托咪定(试药组，n = 15)给药处理，给药时间从麻醉诱导至体外循环结束。分别于术前(T0)，麻醉诱导后10 min(T1)，体外循环结束后5 min(T2)，T2点后2 h(T3)，术后第1天(POD1)和术后第2天(POD2)测定血肌酐水平(SCr)并计算肾小球滤过率估值(eGFR)。急性肾功能损伤(AKI)定义为SCr绝对值增加超过3 mg/L或是上升幅度超过50%。 结果 对比对照组，试药组中围术期AKI发病率显著降低(P < 0.05)。T2和T3点测定对照组中eGFR水平较试药组显著降低(P < 0.05)。 结论 术中给药右美托咪定有助于降低AKI的发病率并有效防止体外循环结束后eGFR水平的下降。     

右美托咪定对高血压病患者全麻气管插管时血流动力学的影响

目的:观察右美托咪定对高血压患者全麻诱导气管插管时血流动力学影响。方法:选取40例需气管插管全麻手术的高血压病患者,随机分为试药组和对照组(每组20例),分别在麻醉诱导前10 min泵入右美托咪定1μg/kg和生理盐水。记录给药前(基础值T0)、给药后(T1)、麻醉诱导后(T2)、插管后即刻(T3)、插管后3、5和10 min(T4、T5、T6)时患者心率(HR)、收缩压(SBP)、舒张压(DBP)和脑电双频指数(BIS)的变化。记录麻醉诱导时丙泊酚的用量。结果:对照组T3、T4时HR、SBP和DBP均比T0时显著升高(P0.05,P0.01)。试药组T3~T5时HR、SBP和DBP分别与T0时比较无显著差异。试药组T3、T4时HR、SBP和DBP显著低于对照组同一时间点(P0.05,P0.01)。试药组在T5时HR和SBP显著低于对照组同一时间点(P0.05)。诱导时试药组丙泊酚用量(113±22)mg显著低于对照组(140±25)mg(P0.01)。试药组T1时BIS值(73±4)显著低于C组(97±2)(P0.01)。结论:麻醉诱导前给予右美托咪啶1μg/kg能显著抑制气管插管时血流动力学反应,减少诱导时丙泊酚用量。     

右美托咪定对止血带下行下肢手术老年高血压患者血流动力学的影响

<正>在下肢手术中,为提高术野的清晰度及止血效果,常需使用止血带。老年高血压患者常合并冠心病、糖尿病等疾病,在应用止血带充气过程中可引起血流动力学的剧烈波动,使这些患者发生心肌缺血甚至心肌梗死的风险大大增加。高选择性α2受体激动剂右美托咪定可产生剂量依赖性的镇静、镇痛及抗焦虑作用,可有效抑制手术应激状态下异常增高的血压和心率,保持血流动力学稳定〔1〕。本研究探讨右美托咪定对老年高血压患者应用止血带行下肢骨科矫形手术血流动力学的影响。     

右美托咪定对老年心血管病患者全麻下腹腔手术时麻醉苏醒期血流动力学指标的影响

目的观察右美托咪定对老年心血管病患者全麻下腹腔手术时麻醉苏醒期血流动力学指标的影响。方法88例择期行全麻腹腔手术的老年心血管病患者,按随机数字表法将其分为两组(n=44):右美托咪定组(A组)和对照组(B组),A组麻醉诱导后15min内静脉泵注右美托咪定1.0μg/kg,随后0.6μg(kg·h)速率输注至手术结束前30min,B组输注等容量生理盐水。两组均采用全身麻醉,记录术前、用药前、停药后及拔管期间血压、心率、瑞芬太尼和异丙酚使用总量,并采静脉血检测术前、术后2h、4h、12h和24h的肾上腺素(Epinephrine,E)、去甲肾上腺素(Norepinephrine,NE)和内皮素-1(Endothelin 1,ET-1)的水平。拔管后15min内记录患者不良反应的情况。结果 A组拔管期血压明显低于B组(均P0.05);A组瑞芬太尼和异丙酚使用量明显少于B组(均P0.05);A组呛咳次数显著少于B组(χ2=6.73,P0.05);A组术后2h、4h、12h和24h的E、NE和ET-1水平均显著低于B组(t=3.02~4.74,均P0.05)。结论全麻时持续静脉输注右美托咪定可改善老年心血管病全麻下腹腔手术患者麻醉苏醒期血流动力学指标的稳定性。     

右美托咪定在婴儿先天性心脏病术后急性肾损伤中的作用

目的 探讨右美托咪定在婴儿先天性心脏病术后急性肾损中的作用。方法 对2014年6月至2016年6月武汉亚洲心脏病先心病区收治的年龄小于6月行先天性心脏病根治后的238例患儿资料进行回顾性匹配队列研究。记录相似基线和人口特征两组患儿，记录比较是否接受右美托咪定治疗急性肾损伤发生率、术后连续3天肌酐值和术后第2天液体超负荷值；比较两组患儿30天死亡率、机械通气时间、ICU停留时间、住院时间差异；分析右美托咪定对发生急性肾损伤患儿的的影响。结果 接受右美托咪定治疗婴儿心脏术后患急性肾损伤机率更低、风险更小、整体术后48小时液体超负荷值更低；两组患儿机械通气时间、ICU停留时间和住院时间比较无差异。结论 先天性心脏病婴儿术后接受右美托咪定治疗可以减少急性肾损伤发病率，减少术后液体超负荷，并不影响患儿的整体临床结局，需要更开展前瞻性研究进一步的确认这个结论。     

右美托咪定对老年颅脑手术全身麻醉患者唤醒试验质量的影响

目的观察右美托咪定对老年颅脑手术全麻患者唤醒试验质量的影响。方法行颅脑手术的老年患者56例随机分为观察组和对照组,术中两组采用丙泊酚复合瑞芬太尼全麻,在唤醒前30 min停止全麻,观察组负荷量右美托咪啶0.25μg/kg稀释至30 ml静脉泵注,然后以0.2μg·kg-1·h-1维持输注;对照组以生理盐水30 ml静脉泵注。比较两组唤醒前30 min(T1)、唤醒即刻(T2)、唤醒后5 min(T3)、唤醒试验后加深麻醉10 min(T4)时心率(HR)、平均血压(MAP)、脑电双频谱指数(BIS)及唤醒时间、唤醒试验期间不良事件和术中知晓等的情况。结果 1两组T2和T3时MAP、HR和BIS均较T1显著升高(P0.01),并且观察组MAP、HR和BIS均较对照组显著降低(P0.01);2两组唤醒时间差异无统计学意义(P0.05),观察组高血压发生率较对照组显著降低(P0.01),未出现心动过速、呛咳、躁动、头痛、术中知晓。结论右美托咪定可提高颅脑手术全麻老年患者的唤醒试验质量。     

右美托咪定对神经外科手术患者全身麻醉后苏醒期躁动的影响

目的探讨右美托咪定减少神经外科手术患者麻醉苏醒期躁动（EA）的效果及安全性。方法将30例行全麻神经外科手术患者随机分为观察组和对照组各15例,两组麻醉诱导用药及术中处理相同,其中观察组围麻醉期应用右美托咪定。观察两组手术时间及麻黄碱和阿托品使用例数;记录不同时点心率、血压、SpO2及手术结束后首次自主呼吸出现时间、气管导管拔除时间、镇静一躁动（SAS）评分、Ramsay评分、疼痛视觉模拟评分法（VAS）评分。结果观察组麻醉诱导后10min、气管导管拔除时心率及收缩压较对照组显著降低,使用阿托品纠正窦性心动过缓的例数明显高于对照组,拔管时SAS评分及VAS评分均明显低于对照组,Ramsay评分显著高于对照组（P均〈0．05）;两组其余指标无显著差异。结论右美托咪定可减少神经外科手术患者EA发生,且对呼吸、循环功能无明显抑制作用。     

右美托咪定复合七氟烷对老年全麻手术患者血流动力学的影响

目的研究右美托咪定复合七氟烷对老年全麻手术患者血流动力学的影响。方法选取2012年10月至2014年10月该院收治的行择期全麻手术的老年患者100例,按照随机数字表法分为研究组和对照组,每组50例,研究组给予右美托咪定复合七氟烷麻醉,对照组给予生理盐水,测量两组患者诱导前(T0)、给药10 min(T1)、睫毛反射消失(T2)、意识消失(T3)、气管插管时(T4)及气管插管后3min(T5)时的平均动脉压和心率,并观察两组不良反应情况。结果研究组T1、T2和T3时平均动脉压和心率低于T0,与T0时比较无统计学意义(P0.05);T4和T5时均高于T0,与T0时比较无统计学意义(P0.05);对照组T1、T2和T3时平均动脉压和心率低于T0,与T0时比较无统计学意义(P0.05),T4和T5显著高于T0,与T0时比较有统计学意义(P0.05),与研究组比较差异显著(P0.05);研究组不良反应发生率显著低于对照组(P0.05)。结论右美托咪定复合七氟烷用于老年全麻手术具有较好的麻醉效果,有利于患者血流动力学稳定,且不良反应少。     

Coronary artery disease screening in adults with congenital heart disease prior to cardiac surgery

Objective: As adults with congenital heart disease (CHD) grow older, preoperative screening for coronary artery disease (CAD) may be indicated prior to CHD surgery. Data regarding the indications for preoperative CAD screening in this population are limited. Current practice is to follow guidelines for patients with valvular heart dis‐ ease; however, the risk for CAD in certain congenital heart diagnoses may be higher than the general population. This study aimed to assess the results of preoperative CAD screening in patients prior to CHD surgery.
Design: Retrospective study.
Setting: Single tertiary center.
Patients: Patients ≥35 years that had CHD surgery from 1/1/2007 to 5/1/2017.
Outcome Measures: Data regarding CAD risk factors and preoperative CAD screen‐ ing results were obtained. Prevalence and risk factors for CAD were analyzed, along with their relationship to perioperative outcomes.
Results: A total of 73 patients underwent CAD screening with either cardiac catheteri‐ zation (56%) or computed tomography angiography (34%) prior to CHD surgery. Overall 16 (22%) patients were found to have CAD. Only two patients had severe coronary stenosis and underwent coronary bypass grafting at time of CHD surgery. Patients with CAD were more likely to be older and have history of hypertension, dyslipidemia, and tobacco smoking. CHD diagnosis was not significantly associated with presence of CAD.
Conclusion: CAD is common in asymptomatic older patients referred for screening prior to CHD surgery; however, severe CAD requiring concomitant coronary inter‐ vention is uncommon. Preoperative CAD screening should be based on age and tra‐ ditional CAD risk factors, rather than underlying CHD.     

Vasopressor magnitude predicts poor outcome in adults with congenital heart disease after cardiac surgery

Background: High levels of vasoactive inotrope support (VIS) after congenital heart surgery are predictive of morbidity in pediatric patients. We sought to discern if this relationship applies to adults with congenital heart disease (ACHD).
Methods: We retrospectively studied adult patients (≥18 years old) admitted to the intensive care unit after cardiac surgery for congenital heart disease from 2002 to 2013 at Mayo Clinic. Vasoactive medication dose values within 96 hours of admis‐ sion were examined to determine the relationship between VIS score and poor out‐ come of early mortality, early morbidity, or complication related morbidity.
Results: Overall, 1040 ACHD patients had cardiac surgery during the study time frame; 243 (23.4%) met study inclusion criteria. Sixty‐two patients (25%), experi‐ enced composite poor outcome [including eight deaths within 90 days of hospital discharge (3%)]. Thirty‐eight patients (15%) endured complication related early mor‐ bidity. The maximum VIS (maxVIS) score area under the curve was 0.92 (95% CI: 0.86‐0.98) for in‐hospital mortality; and 0.82 (95% CI: 0.76‐0.89) for combined poor clinical outcome. On univariate analysis, maxVIS score ≥3 was predictive of compos‐ ite adverse outcome (OR: 14.2, 95% CI: 7.2‐28.2; P < 0.001), prolonged ICU LOS ICU LOS (OR: 19.2; 95% CI: 8.7‐42.1; P < 0.0001), prolonged mechanical ventilation (OR: 13.6; 95% CI: 4.4‐41.8; P < 0.0001) and complication related morbidity (OR: 7.3; 95% CI: 3.4‐15.5; P < 0.0001).
Conclusions: MaxVIS score strongly predicted adverse outcomes and can be used as a risk prediction tool to facilitate early intervention that may improve outcome and assist with clinical decision making for ACHD patients after cardiac surgery.     

A comparison of arterial versus venous-activated clotting time in patients with congenital heart disease undergoing cardiac catheterization

Studies in adult patients undergoing percutaneous coronary angioplasty have demonstrated differences in measured activated clotting time (ACT) in venous vs. arterial blood samples. Ninety-two patients with congenital heart disease undergoing cardiac catheterization were prospectively evaluated to compare venous vs. arterial ACT values in monitoring heparin effect in this population. Simultaneous venous and arterial ACT samples were drawn at baseline, 10 min, 60 min, and every 30 min thereafter until each case was finished. ACT values were determined simultaneously with a dual-chambered Hemochron 801 instrument. At baseline and throughout the study up to 90 min, venous and arterial ACT values were not significantly different. They were also no different in the subgroup of cyanotic patients. Therefore, venous and arterial ACT values can be safely used alternatively to guide heparin dosing during cardiac catheterization in patients with congenital heart disease without the risk of undercoagulation. Cathet. Cardiovasc. Intervent. 46:194–196, 1999. © 1999 Wiley-Liss, Inc.     

Effect of dexmedetomidine on perioperative hemodynamics and organ protection in children with congenital heart disease: A randomized controlled trial

Background: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.Methods: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.Results: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.Conclusions:Dex anesthesia can effectively maintain hemodynamic stability and diminish organ injuries in CHD children.     

Is it safe to perform cardiac catheterizations on adults with congenital heart disease in a pediatric catheterization laboratory?

OBJECTIVE: To determine the complication rate during the catheterization in adults with congenital heart disease (CHD) in a pediatric catheterization laboratory (PCL). BACKGROUND: An increasing number of patients with CHD are surviving into adulthood, with diagnostic and interventional cardiac catheterization being essential for the management of their disease. The complication rate during the catheterization of adults with CHD has not been reported. METHODS: A retrospective chart review was performed on all adult patients (>18 years) with CHD who underwent diagnostic or interventional catheterization in our PCL within the past 8.5 years. RESULTS: A total of 576 procedures were performed on 436 adult patients (median age 26 years). Complex heart disease was present in 387/576 (67%) procedures. An isolated atrial septal defect or patent foramen ovale was present in 115/576 (20%) procedures, and 51/576 (9%) procedures were performed on patients with structurally normal hearts with arrhythmias. Interventional catheterization was performed in 378/576 (66%) procedures. There were complications during 61/576 (10.6%) procedures; 19 were considered major and 42 minor. Major complications were death (1), ventricular fibrillation (1), hypotension requiring inotropes (7), atrial flutter (3), retroperitoneal hematoma, pneumothorax, hemothorax, aortic dissection, renal failure, myocardial ischemia and stent malposition (1 each). The most common minor complications were vascular entry site hematomas and hypotension not requiring inotropes. Procedures performed on patients > or = 45 years of age had a 19% occurrence of complications overall compared with 9% occurrence rate in patients of age < 45 years (P < 0.01). CONCLUSIONS: The complication rate during the catheterization of adults with CHD in a PCL is similar to the complication rate of children with CHD undergoing cardiac catheterization. The older subset of patients are more likely to encounter complications overall. The encountered complications could be handled effectively in the PCL. With screening in place, it is safe to perform cardiac catheterization on most adults with CHD in a PCL.     

Atrial fibrillation in adults with congenital heart disease following cardiac surgery in a single center: Analysis of incidence and risk factors

Objective: The primary aim of our work is to determine the incidence of atrial fibrillation following cardiac surgery in adults with congenital heart disease. Secondary aims include identifying risk factors predictive of developing early postoperative atrial fibrillation and morbidities associated with early postoperative atrial fibrillation.
Design: Retrospective analysis.
Setting: Single center, quaternary care children’s hospital.
Patients: This review included patients at least 18 years of age with known congenital heart disease who underwent cardiac surgery requiring a median sternotomy at our congenital heart center from January 1, 2012 to December 31, 2016.
Interventions: None.
Outcome Measures: The primary outcome was early postoperative atrial fibrillation. Secondary outcomes included preoperative comorbidities, preoperative echocardiographic findings, operative details, and postoperative morbidities, such length of stay, reintubation, stroke, and death.
Results: The incidence of early postoperative atrial fibrillation was 21%. Those who developed early postoperative atrial fibrillation were older (50 years vs 38 years, P =< .001), had a history of atrial fibrillation prior to surgery, had preoperative pulmonary hypertension, and had longer cardiopulmonary bypass times (103 minutes vs 84 minutes, P = .025) when compared to those who did not develop postoperative atrial fibrillation. Multivariate analysis identified age greater than 60, preoperative pulmonary hypertension, mitral valve intervention, and the need for postoperative inotropic support as being independent predictors of postoperative atrial fibrillation. Those who developed postoperative atrial fibrillation remained in the hospital longer (9 days vs 7 days, P =< .001).
Conclusions: Atrial fibrillation is a common complication following cardiac surgery in adults with congenital heart disease. Age, preoperative comorbidities, type of surgical intervention, and the need for perioperative inotropic infusions may predict the risk of atrial fibrillation in this unique patient population.     

右美托咪定在高血压病患者局麻眼科手术中的临床应用

目的：观察右美托咪定在高血压病患者局麻眼科手术中的临床应用效果。方法：60例择期眼科手术的原发性高血压患者,随机分为右美托咪定组（试药组,n=30）和对照组（n=30）;右美托咪定组患者术前先经输液泵缓慢静脉注射盐酸右美托咪定0．5μgkg负荷剂量,10min泵完,然后以0．2μg/（kg·h）速率持续泵注至术毕;对照组给予相同容量的生理盐水。两组患者均在局麻下完成眼科手术。记录两组患者麻醉前（T0）,注射局麻药时（T,）,手术30min（T2）,术毕（T3）时无创袖带收缩压（SBP）、舒张压（DBP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼吸频率（RR）、镇痛镇静评分及不良反应。结果：在T1、T2、T3时点,试药组HR、SBP、DBP、RR、疼痛VAS评分均显著低于对照组（P〈0．01）;而镇静Ramsay评分显著高于对照组（P〈0．01）;试药组与对照组各个时间点SpO2均保持在95％以上,未见明显统计学差异。试药组患者术中使用降压药乌拉地尔次数少于对照组,而术毕舒适度评分高于对照组（均P〈0．01）。两组患者麻醉手术中恶心、呕吐、呼吸抑制等不良反应发生率未见统计学差异。结论：小剂量右美托咪定用于高血压病患者的局麻眼科手术,可以有效减少术中血流动力学波动,镇静镇痛满意,患者舒适度高。     

右美托咪定对心外科术后患者睡眠质量的改善作用

目的研究右美托咪定对心外科术后患者睡眠质量的影响。方法利用多导睡眠图对2018年1月至2018年12月长海医院心脏术后患者进行睡眠监测,选择最终符合条件的患者63例为研究对象,按随机数字表法分为试验组32例和对照组31例。试验组患者从晚上22:00试验开始时持续静脉注射右美托咪定,次日晨6:00停止注射,连续注射3晚。镇静目标为镇静程度评估表(richmond agitation-sedation scale,RASS)评分-1~2分,右美托咪定的负荷剂量为0.5μg/kg,时间不超过20 min,然后以0.2~0.7μg/(kg·h)持续静脉注射,期间不使用其他镇静剂。对照组患者晚间不注射右美托咪定以及其他镇静药物。此段时间用多导睡眠仪监测两组患者的睡眠。观察目标为两组患者睡眠总时间、睡眠效率、觉醒次数、睡眠各阶段时间。试验期间白天的睡眠由床旁护士记录患者睡眠次数。结果试验组与对照组比,有更少的觉醒次数[(3.1~3.61)次vs.(8.87~9.77)次,P<0.01],更高的睡眠效率(68%~71.29%vs.25.1%~28.87%,P<0.01),更长的睡眠第二阶段[(249.55~266.89)min vs.(59.12~71.59)min,P<0.01],差异有统计学意义。两组患者睡眠第一阶段比较,差异无统计学意义[(63.61~7.05)min vs.(56.37~63.33)min,P>0.05]。结论夜间持续输注右美托咪定显著提高了患者睡眠效率、减少睡眠觉醒次数、增加睡眠第二阶段的时间,在一定程度上改善了心外科术后患者的睡眠质量。