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右美托咪啶在先天性心脏病患儿中的临床应用陆海松王晓凑晏馥霞[摘要]背景右美托咪啶(dexmedetomidine,DEX)是新一代高选择性α2肾上腺素能受体激动剂，具有镇静、镇痛和抗交感作用。虽然DEX还未被批准用于18岁以下患者，但已有许多在小儿心脏外科使用的文献报道。目的总结DEX在先天性心脏病（先心病）患儿中的临床应用近况。内容除最常用于围术期重症监护治疗外，DEX在小儿心脏外科还可用于各种诊疗时的镇静、作为麻醉辅助用药、治疗快速型室上性心动过速和治疗阿片药及苯二氮萆类药物的撤药反应。趋向DEX的安全范围较宽，对呼吸影响小，特别是对心肺功能严重受损的重症先心病患儿能发挥独特的优势。右美托咪啶；先天性心脏病；小儿ClinicaluseofdexmedetomidineinpediatricpatientswithcongenitalheartdiseaseLUHai-songWANGXiao-couYANFu-xiaDepartmentofAnesthesiology,CardiovascularInstituteandFuWaiHospital,ChineseAcademyofMedicalScienceandPekingUnionMedicalCollege,Beijing100037,ChinaBackgroundDexmedetomidine(DEX)isanovelhighlyselectiveα2-adrenoceptoragonistwithsedative,analgesic,andanxiolyticeffects.AlthoughithasnotbeenapprovedbytheUSFDAforpediatricpatientsunder18yearsold,therearealotofliteraturesfocusingonitsusinginpediatricpatientswithcongenitalheartdisease.ObjectiveThispaperdiscussestheapplicationofDEXinchildrenwithcongenitalheartdiseaseindetail.ContentTheclinicalapplicationsofDEXincardiacsurgeryincludesedativeinpediatricintensivecareunit,sedationduringnon-invasiveandinvasiveprocedures,aspartofmultimodalanestheticregimen,treatmentofsupraventriculartachyarrhymiasandpreventionofdrugwithdrawal.TrendDEXisasafechugwhileusingincriticallyillpatients,withadvantageofwidedoserangeandminimalrespiratorydepression.Dexmedetomidine;Congenitalheartdisease;Pediatricpatientsl0.3760/cma.j.issn.1673-4378.2011.10.026100037，中国医学科学院北京协和医学院阜外心血管病医院麻醉科（陆海松、晏馥霞）；昆明医学院第一附属医院麻醉科（王晓凑）万方数据 614万方数据 615万方数据 neonate.AnnPharmacother,2009,43(10):1707-1713.@@12.EnomotoY,KudoT,SaitoT,etal.Prolongeduseofdexmedetomidineinaninfantwithrespiratoryfailurefollowinglivingdonorlivertransplantation.PediatrAneasth,2006,16(12):1285-1288.@@1.PhanH,NahataMC.Clinicalusesofdexmedetomidineinpediatric@@13.SasakiT,NemotoS,OzawaH,etal.Plannedsedationwithpatients.PaediatrDrugs,2008,10(1):49-69.dexmedetomidinehydrochlorideafterpediatriccardiacsurgery:an@@2.SuF,NicolsonSC,GastonguayMR,etal.Populationinstitutionalexperience.KyobuGeka,2009,62(2):101-105.pharmacokineticsofdexmedetomidineininfantsafteropenheart@@14.ChrysostomouC,DiFilippoS,ManriqueAM,etal.Useofsurgery.AnesthAnalg,2010,110(5):1383-1392.dexmedetomidineinchildrenaftercardiacandthoracicsurgery.@@3.PottsAL,AndersonBJ,WarmanGR,etal.DexmedetomidinePediatrCritCareMed,2006,7(2):126-131.pharmacokineticsinpediatricintensivecare-apooledanalysis.@@15.LazolJP,LichtensteinSE,JoosteEH,etal.EffectofPaediatrAnaesth,2009,19(11):1119-1129.dexmedetomidineonpulmonaryarterypressureaftercongenital@@4.GetrlerR,BrownHC,MitchellDH,etal.Dexmedetomidine:acardiacsurgery:apilotstudy.PediatrCritCareMed,2010,11novelsedative-analgesicagent.Proc(BaylUnivMedCent),2001,(5):589-592.14(1):13-21.@@16.TokuhiraN,AtagiK,ShimaokaH,etal.Dexmedetomidine@@5.HeardCM,JoshiP,JohnsonK.Dexmedetomidineforpediatricsedationforpediatricpost-Fontanprocedurepatients.PediatrCritMRIsedation:areviewofaseriesofcases.PaediatrAnaesth,CareMed,2009,10(2):207-212.2007,17(9):888-892.@@17.SenzakiH,IshidoH,IwamotoY,etal.Sedationofhypercyanotic@@6.MunroHM,TirottaCF,FelixDE,etal.InitialexperiencewithspellsinaneonatewithtetralogyofFallotusingdexmedetomidine.dexmedetomidinefordiagnosticandinterventionalcardiacJPediatr(RioJ),2008,84(4):377-380.catheterizationinchildren.PaediatrAnaesth,2007,17(2):109-112.@@18.ChrysostomouC,BeermanL,ShiderlyD,etal.Dexmedetomidine:a@@7.KorukS,MizrakA,KayaUgurB,etal.Propofol/dexmedetomidinenoveldrugforthetreatmentofatrialandjunctionalandpropofol/ketaminecombinationsforanesthesiainpediatrictachyarrhythmiasduringtheperioperativeperiodforcongenitalpatientsundergoingtranscatheteratrialseptaldefectclosure:acardiacsurgery:apreliminarystudy.AnesthAnalg,2008,107prospectiverandomizedstudy.ClinTher,2010,32(4):701-709.(5):1514-1522.@@8.BartonKP,MunozR,MorellVO,etal.Dexmedetomidineasthe@@19.FinkelJC,JohnsonYJ,QuezadoZM.Theuseofdexmedetomidineprimarysedativeduringinvasiveproceduresininfantsandtoddlerstofacilitateacutediscontinuationofopioidsaftercardiacwithcongenitalheartdisease.PediatrCritCareMed,2008,9(6):transplantationinchildren.CritCareMed,2005,33(9):2110-2112.612-615.@@20.HammerGB,DroverDR,CaoH,etal.Theeffectsof@@9.MukhtarAM,ObayahEM,HassonaAM.Theuseofdexmedetomidineoncardiacelectrophysiologyinchildren.Anesthdexmedetomidineinpediatriccardiacsurgery.AnesthAnalg,Analg,2008,106(1):79-83.2006,103(1):52-56.@@21.ChrysostomouC,KomarluR,LichtensteinS,etal.@@10.KlamtJG,deAndradeVicenteWV,GarciaLV,etal.EffectsofElectrocardiographiceffectsofdexmedetomidineinpatientswithdexmedetomidine-fentanylinfusiononbloodpressureandheartcongenitalheartdisease.IntensiveCareMed,2010,36(5):836-842.rateduringcardiacsurgeryinchildren.AnesthesiolResPract,2010,2010:869049.@@22.WeberMD,ThammasitboonS,RosenDA.Acutediscontinuation@@11.O'MaraK,GalP,RansommdJL,etal.Successfuluseofsyndromefromdexmedetomidineafterprotracteduseinapediatricdexmedetomidineforsedationina24-weekgestationalagepatient.PaediatrAnaesth,2008,18(1):87-88.万方数据
