El Amrousy Doaa Mohamed, Elshmaa Nagat S, El-Kashlan Mohamed, Hassan Samir, Elsanosy Mohamed, Hablas Nahed, Elrifaey Shimaa, El-Feky Wael
Pediatric Department, Tanta University Hospital, Tanta, Egypt
Department of Anesthesia & Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt.
J Am Heart Assoc. 2017 Mar 1;6(3):e004780. doi: 10.1161/JAHA.116.004780.
Postoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery.
A prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with <0.005. Heart rate while coming off cardiopulmonary bypass was significantly lower in the dexmedetomidine group (130.6±9) than the placebo group (144±7.1) with <0.001. Mean ventilation time, and mean duration of intensive care unit and hospital stay (days) were significantly shorter in the dexmedetomidine group than the placebo group (<0.001). However, there was no significant difference between the 2 groups as regards mortality, bradycardia, or hypotension (>0.005).
Prophylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects.
术后交界性异位性心动过速是小儿心脏手术后发生的最严重的心律失常之一，难以治疗，最好进行预防。我们的目的是评估预防性使用右美托咪定预防小儿心脏手术后交界性异位性心动过速的疗效。
对90例接受先天性心脏病择期心脏手术的儿童进行了一项前瞻性对照研究。患者被随机分为2组。第一组（右美托咪定组）：60例患者接受右美托咪定；第二组（安慰剂组）：30例患者静脉注射等量生理盐水。主要结局是术后交界性异位性心动过速的发生率。次要结局包括心动过缓、低血压、血管活性药物评分、通气时间、儿科心脏监护病房住院时间、住院时间和围手术期死亡率。与安慰剂组（16.7%）相比，右美托咪定组（3.3%）交界性异位性心动过速的发生率显著降低，P<0.005。右美托咪定组在脱离体外循环时的心率（130.6±9）显著低于安慰剂组（144±7.1），P<0.001。右美托咪定组的平均通气时间、重症监护病房平均住院时间和住院天数均显著短于安慰剂组（P<0.001）。然而，两组在死亡率、心动过缓或低血压方面无显著差异（P>0.005）。
先天性心脏病手术后预防性使用右美托咪定可显著降低小儿术后交界性异位性心动过速的发生率，且无明显副作用。
