Chaki Tomohiro, Nawa Yuko, Tamashiro Keishi, Mizuno Eri, Hirata Naoyuki, Yamakage Michiaki
Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Ann Card Anaesth. 2017 Jan-Mar;20(1):33-37. doi: 10.4103/0971-9784.197827.
Cardiopulmonary bypass (CPB) can cause stress response that increases levels of cytokine and catecholamine in plasma, resulting in hyperglycemia. In adults, it has been demonstrated that remifentanil infusion during CPB could prevent increases of cytokine, catecholamine, and blood glucose levels, but such effects of remifentanil in children have not been elucidated.
In this study, we investigated the preventive effects of remifentanil on blood glucose and lactate levels during CPB in children.
This retrospective study included children who underwent ventricular septal defect or atrial septal defect closure. Data for patients who did not receive, during CPB period, remifentanil infusion (non-Remi group) and patients who received remifentanil infusion at 0.5 μg/kg/min (Remi group) during CPB were used for analysis. Primary outcomes were lactate and blood glucose levels just before and after CPB. Data are presented as medians and interquartile ranges. Data were analyzed by the Mann-Whitney U-test and Chi-square test. A P < 0.05 was considered statistically significant.
During CPB, 13 and 11 patients were allocated into Remi and non-Remi groups, respectively. Pre-CPB lactate and blood glucose levels were not significantly different between the two groups, but post-CPB lactate and blood glucose levels in the Remi group were significantly lower than that in the non-Remi group.
0.5 μg/kg/min remifentanil infusion during CPB suppresses the increases of blood glucose and lactate levels in children.
体外循环（CPB）可引发应激反应，导致血浆中细胞因子和儿茶酚胺水平升高，进而引起高血糖。在成人中，已证实CPB期间输注瑞芬太尼可预防细胞因子、儿茶酚胺和血糖水平升高，但瑞芬太尼在儿童中的此类作用尚未阐明。
在本研究中，我们调查了瑞芬太尼对儿童CPB期间血糖和乳酸水平的预防作用。
这项回顾性研究纳入了接受室间隔缺损或房间隔缺损修补术的儿童。分析CPB期间未接受瑞芬太尼输注的患者（非瑞芬组）和CPB期间接受0.5μg/kg/min瑞芬太尼输注的患者（瑞芬组）的数据。主要结局指标为CPB前后的乳酸和血糖水平。数据以中位数和四分位间距表示。采用Mann-Whitney U检验和卡方检验进行数据分析。P<0.05被认为具有统计学意义。
CPB期间，分别有13例和11例患者被分配到瑞芬组和非瑞芬组。两组CPB前的乳酸和血糖水平无显著差异，但瑞芬组CPB后的乳酸和血糖水平显著低于非瑞芬组。
CPB期间输注0.5μg/kg/min瑞芬太尼可抑制儿童血糖和乳酸水平的升高。
