Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15224, USA.
Ann Thorac Surg. 2011 Sep;92(3):964-72; discussion 972. doi: 10.1016/j.athoracsur.2011.04.099.
Postoperative tachyarrhythmias remain a common complication after congenital cardiac operations. Dexmedetomidine (DEX), an α-2 adrenoreceptor agonist, can have a therapeutic role in supraventricular tachyarrhythmias for cardioversion to sinus rhythm or heart rate control. Whether routine perioperative use of DEX decreases the incidence of supraventricular and ventricular tachyarrhythmias was studied.
In this prospective cohort study, 32 pediatric patients undergoing cardiothoracic operations received DEX and were compared with 20 control patients who did not receive DEX.
Dexmedetomidine was started after anesthesia induction and continued intraoperatively and postoperatively for 38±4 hours (mean dose, 0.76±0.04 μg/kg/h). Ten control patients and 2 DEX patients sustained 16 episodes of tachyarrhythmias (p=0.001), including a 25% vs 0% (p=0.01) incidence of ventricular tachycardia and 25% vs 6% (p=0.05) of supraventricular arrhythmias in the control and DEX group, respectively. Transient complete heart block occurred in 2 control patients and in 1 DEX patient. Control patients had a higher heart rate (141±5 vs 127±3 beats/min, p=0.03), more sinus tachycardia episodes (40% vs 6%; p=0.008), required more antihypertensive drugs with nitroprusside (20±7 vs 4±1 μg/kg; p=0.004) and nicardipine (13±5 vs 2±1 μg/kg; p=0.02), and required more fentanyl (39±8 vs 19±3 μg/kg; p=0.005).
Perioperative use of dexmedetomidine is associated with a significantly decreased incidence of ventricular and supraventricular tachyarrhythmias, without significant adverse effects.
术后心动过速仍是先天性心脏手术后的常见并发症。右美托咪定（DEX）是一种α-2肾上腺素受体激动剂，在转为窦性心律或控制心率时，对治疗房性和室上性心动过速有一定作用。本研究旨在探讨常规围手术期使用 DEX 是否会降低房性和室性心动过速的发生率。
这是一项前瞻性队列研究，32 名接受心胸手术的儿科患者接受了 DEX 治疗，并与 20 名未接受 DEX 治疗的对照组患者进行比较。
DEX 在麻醉诱导后开始使用，持续至手术期间和术后 38±4 小时（平均剂量为 0.76±0.04μg/kg/h）。10 名对照组患者和 2 名 DEX 患者共发生 16 次心动过速（p=0.001），包括对照组和 DEX 组室性心动过速发生率分别为 25%和 0%（p=0.01）和 25%和 6%（p=0.05），窦性心动过速分别为 40%和 6%（p=0.008）。2 名对照组患者和 1 名 DEX 患者出现短暂性完全性心脏阻滞。对照组患者心率更高（141±5 次/分 vs 127±3 次/分，p=0.03），窦性心动过速发作更多（40% vs 6%；p=0.008），需要更多硝普钠（20±7 与 4±1μg/kg；p=0.004）和尼卡地平（13±5 与 2±1μg/kg；p=0.02）来控制血压，也需要更多芬太尼（39±8 与 19±3μg/kg；p=0.005）。
围手术期使用 DEX 可显著降低室性和室上性心动过速的发生率，且无明显不良反应。
