纳美芬拮抗先天性心脏病患儿术后呼吸抑制的效果

目的 评价纳美芬拮抗先天性心脏病（先心病）患儿术后阿片类药物所致呼吸抑制的效果.方法 选择行先心病择期手术的患儿60例,采用随机数字表法分为3组（每组20例）：对照组（C组）、Ⅰ组、Ⅱ组.手术结束后,患儿带管送入胸外科重症监护室,待生命体征平稳10 min后：C组（对照组）不给予任何拮抗药;Ⅰ组静脉注射纳美芬0.25 μg/kg;Ⅱ组静脉注射纳美芬0.25μg/kg,观察5 min,再次静脉注射纳美芬0.25μg/kg.记录给药前即刻（T1）、给药后5 min（T2）、给药后30 min（T3）、呼吸恢复时（T4）、拔管时（T5）、拔管后1 h（T6）、拔管后3 h（T7）患儿的平均动脉压（mean arterial pressure,MAP）、心率（heart rate,HR）、脉搏血氧饱和度（pulse oxygen saturation,SpO2）和血气分析结果,记录患儿的呼吸恢复时间、拔管时间及心脏病加强监护病房（cardiac intensive care unit,CICU）监护时间,并观察术后恶心、呕吐、发热、躁动、伤口疼痛等副作用的发生率.结果 C组患儿术后呼吸恢复时间、气管导管拔出时间和CICU监护时间分别为（2.9±1.0）、（3.6±1.4）、（18.5±5.8）h,Ⅰ组分别为（1.8±0.6）、（2.3±0.6）、（8.2±3.1）h,Ⅱ组分别为（1.7±0.5）、（2.1±0.7）、（7.9±2.9）h;与C组比较,Ⅰ组和Ⅱ组的各时间均缩短（P＜0.05）.C组患儿术后恶心、呕吐的发生率为15％,Ⅰ组和Ⅱ组的发生率降低,分别为5％和0（P＜0.05）.结论 纳美芬可安全有效地拮抗先心病手术患儿术后阿片类药物所致呼吸抑制作用,且能减少术后副作用发生率.

Efficacy of nalmefene antagonizing postoperative respiratory depression in children with congenital heart disease

Objective To evaluate the efficacy of nalmefene antagonizing postoperative respiratory depression in children with congenital heart disease.Methods Sixty ASA Ⅰ or Ⅱ children,aged 3 y-6 y and undergoing congenital heart disease surgery,were included and randomly divided into 3 groups （n=20）.All the patients were sent into the cardiac intensive care unit （CICU） after surgery.At 10 min following the patients＇ vital sign was stable in the CICU,patients in group Ⅰ were administered intravenously with nalmefene 0.25 μg/kg and group Ⅱ were injected intravenously with nalmefene 0.25 μg/kg twice.Patients in group C were not given drug （control group）.Mean arterial pressure（MBP）,heart rate（HR）,pulse oxygen saturation（SpO2） and blood gas analysis before and after administration,during respiratory recovery,duration of extubation,duration of monitoring in the CICU,and adverse effects including nausea,vomiting,fever,restlessness and wound pain were observed.Results Duration of respiratory recovery,extubation,and monitoring in the CICU were （2.9±1.0）,（3.6± 1.4） h and （18.5±5.8） h in group C,respectively,（1.8± 0.6）,（2.3±0.6） h and（8.2±3.1） h in group Ⅰ,（1.7±0.5）,（2.1±0.7） h and （7.9±2.9） h in group Ⅱ.Duration of respiratory recovery,extubation,and monitoring in the CICU were significantly shorter in groups Ⅰ and Ⅱ than in control group （P〈0.05）.Incidence of postoperative nausea and vomiting was 15%,5% and 0% in groups C,Ⅰ and Ⅱ,respectively,with a lower incidence of postoperative nausea and vomiting in groups Ⅰ and Ⅱ than in group C （P〈0.05）.Conclusions Nalmefene is effective and safe for antagonism of postoperative respiratory depression after congenital heart disease surgery in children.