右美托咪定对小儿扁桃腺摘除术后苏醒的影响

摘要

Objective:To investigate the effect of Dexmedetomidine on recovery process in pediatric anesthesia undergoing tonsil removal surgery. Method:30 patients withⅠtoⅡof ASA physical status,4 to 12 years for radical operations of tonsil removal,were randomly assigned into 2 groups. Patients in the dexmedetomidine group(GroupⅠ,n=15) received an infusion in 10 minutes of Dexmedetomidine 1μg/kg before anesthesia induction and then an infusion of 0.7μg/(kg·h) for maintenance.Patients in the control group(GroupⅡ,n=15) received the same rate and volume of normal saline by infusion.Anesthesia induction was performed using Propofol 2.5 mg/kg,Fentanyl 0.002-0.003 mg/kg,Cis-atracurium 0.1 mg/kg for both GroupⅠand GroupⅡ.Intraoperative Propofol and Remifentanil,Cis-atracurium to maintain anesthesia for both groups.Mean blood pressure(MBP),heart rate(HR), timing of extubation,time of staying in the PACU,adverse effects when awake and suction(T0),extubation time(T1),after extubation 5 min(T2), entering PACU(T3) and out of PACU(T4) were measured and recorded.Result:Comparing with Group Ⅱ,Group Ⅰexperienced less haemodynamic fluctuation(MBP and HR)(P<0.05) at T0 and T1,and lower incidence of pain and restlessness(P<0.05) at T2.There was not statistically significant in MBP and HR between two groups at other time.Comparing with Group Ⅱ,Group Ⅰ experienced lower incidence of pain,restlessness and anxiety(P<0.05). Extubation time,staying in the PACU time,the incidence of vomiting,lethargy incidence difference was no statistically significant between two groups(P>0.05).Conclusion:Dexmedetomidine as an adjunct to general anesthesia for pediatric patients undergoing tonsil removal surgery can keep stable haemodynamics,minimize adverse effects during recovery process.%目的：探讨右美托咪定对小儿扁桃腺摘除术后苏醒的影响。方法：选择ASAⅠ~Ⅱ级、4~12岁、行扁桃腺摘除术的患者30例，随机分为两组。右美托咪定组(Ⅰ组，n=15)在麻醉诱导前静脉恒速微泵注射右美托咪定1μg/kg，10min输注完毕。诱导插管后采用0.7μg/(kg·h)持续静脉微泵注射，手术结束前约半小时停止注射。采用丙泊酚2.5mg/kg，芬太尼0.002~0.003mg/kg，顺阿曲库铵0.1mg/kg诱导，术中以丙泊酚、瑞芬太尼、顺阿曲库铵维持麻醉。对照组(Ⅱ组，n=15)静脉恒速微泵注射等速度和等容量的0.9%氯化钠注射液，麻醉诱导和维持同Ⅰ组。记录两组患者清醒吸痰时(T0)、拔管即刻时(T1)、拔管后5min(T2)、入PACU时(T3)及出PACU时(T4)的平均动脉压(MBP)、心率(HR)。记录拔管时间、入PACU时间、苏醒期疼痛、烦躁、呕吐、嗜睡发生率。结果：T0、T1时Ⅰ组患者MBP、HR均明显低于Ⅱ组患者(P<0.05)；T2时Ⅰ组患者HR明显低于Ⅱ组患者(P<0.05)；其他各时间点Ⅰ组患者与Ⅱ组患者MBP、HR比较差异无统计学意义。Ⅰ组患者较Ⅱ组患者苏醒期疼痛和烦躁的发生率更低(P<0.05)，两组患者的拔管时间、入PACU时间、呕吐发生率、嗜睡发生率比较差异无统计学意义(P>0.05)。结论：小儿患者扁桃体摘除术中联合使用右美托咪定可使苏醒期的血流动力学更加平稳，降低苏醒期疼痛和烦躁的发生。