文章摘要
娄艳芳,梁 冰,王作鹏,顾 青,张 帅.小剂量右美托咪定复合氯胺酮麻醉对先天性心脏病介入封堵术患儿心肌损伤和炎性因子的影响[J].,2022,(6):1043-1047
小剂量右美托咪定复合氯胺酮麻醉对先天性心脏病介入封堵术患儿心肌损伤和炎性因子的影响
Effects of Low-Dose Dexmedetomidine Combined With Ketamine Anesthesia on Myocardial Injury and Inflammatory Factors in Children with Congenital Heart Disease Undergoing Interventional Closure
投稿时间:2021-08-23  修订日期:2021-09-18
DOI:10.13241/j.cnki.pmb.2022.06.009
中文关键词: 小剂量  右美托咪定  氯胺酮  先天性心脏病  介入封堵术  心肌损伤  炎性因子
英文关键词: Low-dose  Dexmedetomidine  Ketamine  Interventional closure  Congenital heart disease  Myocardial injury  Inflammatory factor
基金项目:上海市扬帆计划项目(yf1401400)
作者单位E-mail
娄艳芳 国家儿童医学中心·复旦大学附属儿科医院麻醉科 上海 201102 louyf_@fudan.edu 
梁 冰 国家儿童医学中心·复旦大学附属儿科医院麻醉科 上海 201102  
王作鹏 国家儿童医学中心·复旦大学附属儿科医院普外科 上海 201102  
顾 青 国家儿童医学中心·复旦大学附属儿科医院麻醉科 上海 201102  
张 帅 国家儿童医学中心·复旦大学附属儿科医院麻醉科 上海 201102  
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中文摘要:
      摘要 目的:观察小剂量右美托咪定复合氯胺酮麻醉对先天性心脏病(CHD)介入封堵术患儿心肌损伤和炎性因子的影响。方法:纳入我院2020年6月-2021年6月期间收治的CHD行介入封堵术的患儿60例,根据随机数字表法将患儿分为K组(氯胺酮麻醉,n=30)和KD组(小剂量右美托咪定复合氯胺酮麻醉,n=30)。观察两组患儿血流动力学、心肌损伤和炎性因子指标的变化情况,记录两组患儿围术期间不良反应发生情况。结果:KD组患儿喉罩置入后(T1)~手术结束时(T4)时间点心率(HR)、平均动脉压(MAP)均低于K组患儿(P<0.05)。KD组患儿术后6 h、术后12 h血清心脏型脂肪酸结合蛋白(H-FABP)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平低于K组(P<0.05)。KD组患儿术后6 h、术后12 h血清C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平低于K组(P<0.05)。两组患儿不良反应发生率组间对比无统计学差异(P>0.05)。结论:小剂量右美托咪定复合氯胺酮麻醉用于行CHD介入封堵术患儿,可减轻其血流波动,减少心肌损伤,控制患儿炎症反应,安全可靠。
英文摘要:
      ABSTRACT Objective: To observe the effects of low-dose dexmedetomidine combined with ketamine anesthesia on myocardial injury and inflammatory factors in children with congenital heart disease (CHD) undergoing interventional closure. Methods: 60 children with CHD who underwent interventional closure from June 2020 to June 2021 were included. According to the random number table, the children were divided into group K(ketamine anesthesia, n=30) and group KD(low-dose dexmedetomidine combined with ketamine anesthesia, n=30). The changes of hemodynamics, myocardial injury and inflammatory factors of the two groups were observed, and the perioperative adverse reactions of the two groups were recorded. Results: The heart rate (HR) and mean arterial pressure (MAP) in group KD were lower than those in group K from T1 to T4 after laryngeal mask placement(P<0.05). The levels of serum cardiac fatty acid binding protein (H-FABP), creatine kinase isoenzyme (CK-MB) and cardiac troponin (cTnI) in group KD were lower than those in group K at 6 h and 12 h after operation(P<0.05). The levels of serum C-reactive protein(CRP), interleukin-6(IL-6) and tumor necrosis factor-α (TNF-α) in group KD at 6 h and 12 h after operation were lower than those in group K(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Low-dose dexmedetomidine combined with ketamine anesthesia for children with CHD undergoing interventional closure can reduce blood flow fluctuation, reduce myocardial injury, and control inflammatory reaction in children, which is safe and reliable.
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