右美托咪定对小儿心肺旁路心脏手术中脑血管二氧化碳反应性的影响

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia Pub Date : 2025-03-03 DOI:10.1053/j.jvca.2025.03.002

Liping Sun MD , Kan Zhang MD, PhD , Hong Wang , Wei Ji MD , Yue Huang MD , Jie Bai MD , Jijian Zheng MD, PhD

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引用次数: 0

摘要

目的：应用经颅彩色编码双相超声（TCCD）评价右美托咪定（DEX）对先天性心脏病（CHD）患儿脑血管自身调节的影响。设计：随机对照试验。背景：本单中心研究在中国上海的一家三级医疗中心进行。患者：59名年龄在0 - 6岁的CHD患儿接受了心脏手术和体外循环。干预措施：儿童在麻醉诱导后，随机分为两组，一组使用DEX （DEX组），另一组使用生理盐水（对照组），治疗10分钟。通过调整肺通气评估脑血管二氧化碳反应性（CVR-CO2）。测量结果及主要结果：患者手术前后均行TCCD检查。在三个不同的时间点测量并分析右大脑中动脉CVR-CO2、阻力指数（RI）、脉搏指数（PI）、平均血流速度（Vmean）和右额叶区域脑氧饱和度（ScrO2），共6个测量值。记录各时间点的血流动力学参数，包括心率（HR）和平均动脉压（MAP）。两组间CVR-CO2 （p = 0.402）、PI （p = 0.203）、RI （p = 0.290）、Vmean （p = 0.290）、ScrO2 （p = 0.426）、HR （p = 0.522）、MAP （p = 0.236）具有可比性。对照组PI、RI、HR术前、术后差异有统计学意义。DEX组术前、术后RI、Vmean、ScrO2、HR差异有统计学意义。结论：低负荷剂量的DEX不会降低接受心脏手术合并体外循环的冠心病患儿的CVR-CO2。

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Effect of Dexmedetomidine on Cerebrovascular Carbon Dioxide Reactivity During Pediatric Cardiac Surgery With Cardiopulmonary Bypass

Objective

To assess the effects of dexmedetomidine (DEX) on cerebrovascular autoregulation in children with congenital heart disease (CHD) using transcranial color-coded duplex sonography (TCCD).

Design

Randomized controlled trial.

Setting

This single-center study was conducted at a tertiary care center in Shanghai, China.

Patients

Fifty-nine children aged 0 to 6 years with CHD who underwent cardiac surgery with cardiopulmonary bypass were enrolled.

Intervention

Children were randomly assigned to receive either DEX (DEX group) or normal saline (control group) for 10 minutes following anesthetic induction. Cerebrovascular carbon dioxide reactivity (CVR-CO₂) was assessed by adjustment of lung ventilation.

Measurements and Main Results

Patients underwent TCCD before and after surgery. CVR-CO₂, resistance index (RI), pulsatility index (PI), mean blood flow velocity (V_mean) of the right middle cerebral artery, and regional cerebral oxygen saturation (ScrO₂) of the right frontal lobe were measured and analyzed at three distinct time points, resulting in six measurements. Hemodynamic parameters, including heart rate (HR) and mean arterial pressure (MAP), were recorded at each time point. The parameters CVR-CO₂ (p = 0.402), PI (p = 0.203), RI (p = 0.290), V_mean (p = 0.290), ScrO₂ (p = 0.426), HR (p = 0.522), and MAP (p = 0.236) were comparable between the two groups. In the control group, PI, RI, and HR significantly differed before and after surgery. In the DEX group, RI, V_mean, ScrO_2, and HR significantly differed before and after surgery.

Conclusions

A low loading dose of DEX did not compromise CVR-CO₂ in children with CHD undergoing cardiac surgery with cardiopulmonary bypass.

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来源期刊

Journal of cardiothoracic and vascular anesthesia 医学-呼吸系统

CiteScore

4.80

自引率

17.90%

发文量

606

审稿时长

37 days

期刊介绍： The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.