摘要
目的心跳骤停(cardiac arrest)是右美托咪定最严重的副作用之一,本文拟探讨右美托咪定诱发心跳骤停患者的早期临床表现、防治措施以及潜在风险。方法检索报道右美托咪定给药导致心跳骤停的中、英文献,检索的数据库包括万方、中国知网、维普、PubMed、EMbase。下载全文,利用Microsoft Office Excel软件统计病例报告中患者的基本情况、发病特点、早期表现、预防、治疗及转归。统计分析文献信息、患者基本情况、临床表现、处理及预后。结果最终11篇文献(18例患者)符合纳入标准,且均为英文病例报道文献。18例患者输注右美托咪定期间发生心跳骤停,发生地点分别为手术间10例、重症监护病房7例和心脏介入导管室1例。9例60岁以上的老年人使用右美托咪啶引起的心脏骤停。10例患者使用1μg/kg负荷量输入,其中2例出现窦缓,3例患者出现低血压情况,另外有5例患者输注负荷量10 min内出现心脏骤停。发生心脏骤停后3例患者积极抢救预后较差,心脏不能复跳,其中有2例既往有心律失常房颤病史,1例为肺移植术后患者。术前心律失常6例表现为心脏传导系统功能异常,这些病例中使用右美托咪定发生心跳骤停几率更高。14例患者使用右美托咪定与其他麻醉药物,产生协同作用引发心跳停搏。输注右美托咪定后即刻发现心脏骤停实施心肺复苏,使用阿托品、肾上腺素等抢救药物(1例患者窦性停搏未用药,心跳自行恢复),且大部分短时间内心脏成功复跳。结论右美托咪定有致心脏骤停的风险性,可能与老年患者伴有基础性疾病,术前心脏传导系统功能异常或与其他药物的协同作用有关。
Objective TCardiac arrest is one of the most serious side effects of dexmedetomidine.The aim of this article is to explore the early manifestations,preventions and potential risks of dexmedetomidine in patients with cardiac arrest.Methods We did a comprehensive research in both Chinese and English Databases and searched for articles about cardiac arrest caused by dexmedetomidine.We downloaded the fulltext of all articles that were related,and used Microsoft Office Excel to summarize the history,features of the disease,early signs and symptoms,prevention,treatment and prognosis.Results Totally,11 articles(18 patients)met the criteria of inclusion.All of them were published in English.Eighteen patients had cardiac arrest during infusion of dexmedetomidine,10 cases happened in the operation room,7 cases in the surgical ICU and 1 case in cardiac catheterization laboratory.9 cases of cardiac arrest caused by dexmedetomidine were over 60 years old.Ten patients developed cardiac arrest after receiving 1μg/kg load input as bolus dose.Three patients failed to respond to rescue therapy.Among them,2 cases had a history of arrhythmia and atrial fibrillation and 1 had a history of lung transplantation.Six patients with preoperative arrhythmia showed abnormal cardiac conduction system function,and the incidence of cardiac arrest was higher with dexmedetomidine.In the 18 cardiac-arrested patients,fourteen of them received dexmedetomidine simultaneously with other anesthetics.Once dexmedetomidine-induced cardiac arrest occurred,dexmedetomidine was discontinued and CPR was applied.Atropine and adrenaline were most-often used rescue agents.One patient had sinus arrest without medication and his heartbeat recovered by itself.Most cardiac-arrested patients had successful cardiac resuscitation in a short time,and the prognosis was good.Conclusion Dexmedetomidine has the risk of cardiac arrest,which may be related to the dysfunction of cardiac conduction system or synergistic effect with other drugs in elderly patients with basic diseases before operation.
作者
刘伟
张文杰
姚允泰
李立环
LIU Wei;ZHANG Wen-jie;YAO Yun-tai;LI Li-huan(Anesthesia Center,Fuwai Hospital.Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037;Department of Anesthesia,The Central Hospital of Dalian,Liaoning 116033;Department of Anesthesia,People's Hospital of Lan Ling County,Shandong 277700,China)
出处
《中国分子心脏病学杂志》
CAS
2020年第5期3535-3538,共4页
Molecular Cardiology of China
基金
北京协和医学院青年教师培养项目(2014zlgc0759)。
