丙泊酚静脉麻醉下行斜视手术结束前给予右美托咪定对患儿术后躁动的影响

摘要

目的 观察丙泊酚静脉麻醉下行斜视手术结束前给予右美托咪定对患儿术后躁动的影响.方法 选择2016年12月至2017年5月在中国医科大学附属盛京医院行择期斜视手术的患儿90例.根据随机数字表法分为P组和P+D组,每组45例.P组麻醉中使用丙泊酚,P+D组麻醉中使用丙泊酚的同时于手术结束前20 min静脉泵注右美托咪定0.5μg/kg.记录患儿苏醒时间、拔管时间,比较2组拔管后0、5、10、20、30 min疼痛数字评分量表(NRS)评分、小儿麻醉苏醒期躁动量表(PAED)评分、Ramsay镇静量表(RSS)评分及不良反应发生情况.结果 2组患儿苏醒时间、拔管时间差异无统计学意义(P＞0.05).拔管后0、5、10 min,P+D组NRS和PAED评分均低于P组,RSS评分高于P组[拔管后0min:(1.79±0.83)分比(2.51±0.93)分、(8.7±2.3)分比(l 0.3±2.3)分、(3.8±0.8)分比(2.9±0.7)分;拔管后5min:(1.62±0.59)分比(2.16±0.73)分、(5.6±2.0)分比(6.7±1.5)分、(2.7±0.7)分比(1.8±0.8)分;拔管后10 min:(1.41±0.50)分比(1.89±0.52)分、(3.0±1.8)分比(3.8±1.4)分、(2.2±0.6)分比(1.5±0.5)分],NRS≥3分和PAED≥10分的患者比例低于P组,差异均有统计学意义(均P＜0.05).P+D组患者严重呛咳的发生率明显低于P组,差异有统计学意义[6.7％ (3/45)比22.2％(10/45)](P＜0.05),2组术后呕吐发生率差异无统计学意义(P＞0.05).结论 丙泊酚静脉麻醉下行斜视手术结束前单剂量给予右美托咪定能降低斜视手术患儿术后躁动的发生率,同时不延长苏醒时间和拔管时间,且不增加不良反应发生率.%Objective To observe the effect of dexmedetomidine used before the end of strabismus surgery with intravenous propofol anesthesia on postoperative agitation in children.Methods From December 2016 to May 2017,90 children undergoing strabismus surgery at Shengjing Hospital of China Medical University were randomly divided into group P(n =45) and group P + D(n =45).All children had intravenous propofol anesthesia and the group P + D was intravenously given dexmedetomidine 0.5 μg/kg at 20 min before the end of operation.Recovery time and extubation time were recorded.Scores of Numerical Rating Scale(NRS),Pediatric Anesthesia Emergence Delirium Scale(PAED) and Ramsay Sedation Scale(RSS) were assessed 0,5,10,20,30 min after extubation.Adverse reactions were observed during perioperative period.Restflts There were no significant differences of recovery time and extubation time between groups (P ＞ 0.05).Scores of NRS and PAED in group P + D 0,5,10 min after extubation were significantly lower and RSS score was significantly higher than those in group P [0 min after extubation:(1.79 ± 0.83) vs (2.51 ± 0.93),(8.7 ± 2.3) vs (10.3 ± 2.3),(3.8 ± 0.8) vs (2.9±0.7);5 min after extubation:(1.62 ±0.59) vs (2.16±0.73),(5.6±2.0) vs (6.7 ±1.5),(2.7± 0.7) vs (1.8 ± 0.8);10 min after extubation:(1.41 ± 0.50) vs (1.89 ± 0.52),(3.0 ± 1.8) vs (3.8 ± 1.4),(2.2 ± 0.6) vs (1.5 ± 0.5)] (P ＜ 0.05).Ratios of NRS score ≥ 3 and PAED score ≥ 10 in group P + D were significantly lower than those in group P(P ＜ 0.05).Incidence of severe cough in group P + D was significantly lower than that in group P[6.7％ (3/45) vs 22.2％ (10/45)] (P ＜ 0.05).Incidence of postoperative vomiting showed no significant difference between groups(P ＞ 0.05).Conclusion Single dose of dexmedetomidine used before end of strabismus surgery in children with propofol anesthesia can reduce postoperative agitation without prolonging recovery time,extubation time and increasing adverse reactions.