Chrysostomou Constantinos, Di Filippo Sylvie, Manrique Ana-Maria, Schmitt Carol G, Orr Richard A, Casta Alfonso, Suchoza Erin, Janosky Janine, Davis Peter J, Munoz Ricardo
Department of Critical Care Medicine, Division of Pediatric Cardiac Critical Care, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Pediatr Crit Care Med. 2006 Mar;7(2):126-31. doi: 10.1097/01.PCC.0000200967.76996.07.
In this report, we describe our experience with the use of dexmedetomidine in spontaneously breathing as well as in mechanically ventilated patients, after congenital cardiac and thoracic surgery.
Retrospective case series.
University hospital, pediatric cardiac intensive care unit.
Thirty-three spontaneously breathing and five mechanically ventilated patients who received dexmedetomidine after cardiothoracic surgery.
None.
Thirty-eight patients, age 8 +/- 1.1 yrs old and weight 29 +/- 3.8 kg, were included. Seven patients (18%) were <1 yr old. Dexmedetomidine was used as a primary sedative and analgesic agent, and when its effect was considered inadequate, despite incremental infusion doses, a rescue agent was administered. The initial dexmedetomidine infusion dose was 0.32 +/- 0.15 microg/kg/hr followed by an average infusion of 0.3 +/- 0.05 microg/kg/hr (range 0.1-0.75 microg/kg/hr). There was a trend toward higher dexmedetomidine infusion requirement in patients <1 yr old compared with older children, 0.4 +/- 0.13 vs. 0.29 +/- 0.17 microg/kg/hr (p = .06). Desired sedation and analgesia were achieved during 93% and 83% of the dexmedetomidine infusion, respectively. According to the intensive care unit sedation scale (score 0-3) and two pain scales (Numeric Visual Analog Scale and Face, Legs, Activity, Cry, and Consolability, score 0-10), the mean sedation score was 1.3 +/- 0.6 (mild sedation) and the mean pain score was 1.5 +/- 0.9 (mild pain). The most frequently rescue drugs administered were fentanyl, morphine, and midazolam. Overall, 49 rescue doses of sedatives/analgesics were given. Patients <1 yr old required more rescue boluses than older children, 22 boluses (3.19 +/- 0.8) vs. 27 boluses (0.8 +/- 0.2, p = .003). Throughout the dexmedetomidine infusion there was no significant change in the systolic and diastolic blood pressure trend. Six patients (15%) had documented hypotension. In three, hypotension resolved with decreasing the dexmedetomidine infusion dose whereas in the other three, hypotension resolved after discontinuing the infusion. Although there was a trend toward lower heart rates, this was not clinically significant. One patient had an episode of considerable bradycardia without hypotension, which resolved shortly after discontinuing the dexmedetomidine infusion. No significant changes in the arterial blood gases or respiratory rates were observed. There was no mortality, and the total intensive care unit length of stay was 19 +/- 2 hrs.
Our data suggest that dexmedetomidine is a well-tolerated and effective agent for both spontaneously breathing and mechanically ventilated patients following congenital cardiac and thoracic surgery.
在本报告中，我们描述了右美托咪定在先天性心脏和胸科手术后自主呼吸以及机械通气患者中的应用经验。
回顾性病例系列。
大学医院，儿科心脏重症监护病房。
33例自主呼吸患者和5例机械通气患者，他们在心胸外科手术后接受了右美托咪定治疗。
无。
纳入38例患者，年龄8±1.1岁，体重29±3.8kg。7例（18%）患者年龄小于1岁。右美托咪定用作主要的镇静和镇痛药物，当认为其效果不足时，尽管增加了输注剂量，仍给予了抢救药物。右美托咪定的初始输注剂量为0.32±0.15μg/kg/小时，随后平均输注剂量为0.3±0.05μg/kg/小时（范围0.1 - 0.75μg/kg/小时）。与大龄儿童相比，年龄小于1岁的患者右美托咪定输注需求量有升高趋势，分别为0.4±0.13与0.29±0.17μg/kg/小时（p = 0.06）。在右美托咪定输注期间，分别有93%和83%的时间达到了理想的镇静和镇痛效果。根据重症监护病房镇静评分（0 - 3分）和两个疼痛评分（数字视觉模拟评分以及面部、腿部、活动、哭闹和安慰度评分，0 - 10分），平均镇静评分为1.3±0.6（轻度镇静），平均疼痛评分为1.5±0.9（轻度疼痛）。最常给予的抢救药物是芬太尼、吗啡和咪达唑仑。总体而言，共给予了49剂镇静剂/镇痛药抢救剂量。年龄小于1岁的患者比大龄儿童需要更多的抢救推注剂量，分别为22次推注（3.19±0.8）与27次推注（0.8±0.2，p = 0.003）。在整个右美托咪定输注过程中，收缩压和舒张压趋势无显著变化。6例（15%）患者记录有低血压。其中3例，低血压通过降低右美托咪定输注剂量得到缓解，而另外3例，低血压在停止输注后得到缓解。尽管心率有降低趋势，但在临床上无显著意义。1例患者出现了一次严重心动过缓但无低血压，在停止右美托咪定输注后不久缓解。未观察到动脉血气或呼吸频率有显著变化。无死亡病例，重症监护病房总住院时间为19±2小时。
我们的数据表明，右美托咪定对于先天性心脏和胸科手术后的自主呼吸和机械通气患者是一种耐受性良好且有效的药物。
