Ortmann Laura A, Keshary Meera, Bisselou Karl Stessy, Kutty Shelby, Affolter Jeremy T
1 Department of Pediatrics, Division of Critical Care, Children's Hospital and Medical Center, Omaha, NE, USA.
2 Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St Louis, MO, USA.
World J Pediatr Congenit Heart Surg. 2019 Jul;10(4):440-445. doi: 10.1177/2150135119842873.
Dexmedetomidine has been suggested as an arrhythmia prophylactic agent after surgery for congenital heart disease due to its heart rate lowering effect, though studies are conflicting. We sought to study the effect of dexmedetomidine in infants that are at highest risk for arrhythmias.
Retrospective cohort study of infants less than six months of age undergoing cardiopulmonary bypass for congenital heart disease. The arrhythmia incidence in the first 48 hours after surgery in infants receiving dexmedetomidine for sedation was compared to those that did not receive dexmedetomidine.
A total of 309 patients were included, 206 patients who did not receive dexmedetomidine and 103 patients who did. The incidence of tachyarrhythmias was similar between the non-DEX group and the DEX group (19% vs 15%, = .34). When adjusted for baseline differences, the non-DEX group did not have an increased risk of postoperative tachyarrhythmias (odds ratio [OR]: 1.4, 95% confidence interval [CI]: 0.5-3.8). The non-DEX group had an increased need for treatment for arrhythmias (18% vs 8%, = .012). The three lesions with baseline higher risk for arrhythmias (tetralogy of Fallot, transposition of the great arteries, and complete atrioventricular canal) had an increased incidence of tachyarrhythmias in the non-DEX group (34% vs 6%, = .027). This risk was not significant in multivariate analysis (OR: 2.5, 95% CI: 0.4-15.5).
High-risk infants had decreased incidence of tachyarrhythmias when receiving dexmedetomidine, though this was not significant after accounting for baseline differences between groups.
右美托咪定因其降低心率的作用，被认为可作为先天性心脏病手术后的心律失常预防药物，尽管相关研究结果存在矛盾。我们试图研究右美托咪定对心律失常风险最高的婴儿的影响。
对小于6个月的先天性心脏病婴儿进行体外循环手术的回顾性队列研究。比较接受右美托咪定镇静的婴儿与未接受右美托咪定的婴儿术后48小时内心律失常的发生率。
共纳入309例患者，其中206例未接受右美托咪定，103例接受了右美托咪定。非右美托咪定组和右美托咪定组的快速性心律失常发生率相似（19%对15%，P = 0.34）。在对基线差异进行校正后，非右美托咪定组术后快速性心律失常的风险并未增加（优势比[OR]：1.4，95%置信区间[CI]：0.5 - 3.8）。非右美托咪定组对心律失常治疗的需求增加（18%对8%，P = 0.012）。在基线时心律失常风险较高的三种病变（法洛四联症、大动脉转位和完全性房室通道）中，非右美托咪定组的快速性心律失常发生率增加（34%对6%，P = 0.027）。在多变量分析中，这种风险并不显著（OR：2.5，95% CI：0.4 - 15.5）。
高危婴儿在接受右美托咪定时快速性心律失常的发生率降低，尽管在考虑组间基线差异后这一差异并不显著。
