右美托咪定对智障儿童全麻下牙科治疗苏醒期躁动的影响

摘要

Objective To investigate the effect of dexmedetomidine on emergence agitation following general anesthesia in mentally retarded children for dental treatment.Methods 49 mentally retarded children, ASA status I or II, scheduled for dental treatment under general anesthesia were enrolled in this study, who were randomly divided into Control (Ctrl group, n=23) and Dexmedetomidine (Dex group, n=26) Group.Anesthesia was induced with sevoflurane, with iv injection of fentanyl 2-3μg/kg, propofol 2-3 mg/kg, and cisatracurium besilate for injection0.15 mg/kg.After intratracheal intubation, anesthesia were maintained with 2％sevoflurane and 100％oxygen.0.5 hbefore the end of surgery, 0.5μg/kg dexmedetomidine or equal volume of normal saline were iv injected within 10 min for Dex group and Ctrl group respectively.Sevoflurane was shut down when the surgery were finished.Patients' medical information and vital signs, emergence agitation and PAED score were recorded.Results Dexmedetomidine did not affect the surgery time, anesthesia time, extubation time and dose of sevoflurane, but effectively decrease the emergence agitation and PAED score, as well as the heart rate.Conclusion For mentally retarded children scheduled for dental treatment under general anesthesia, dexmedetomidine can effectively reduce the emergence agitation.%目的 研究右美托咪定是否能够减少智障儿童全麻下齿科治疗苏醒期躁动.方法 选择需要行非住院全麻下齿科治疗的智障儿童49例,随机分为对照组(Con组)和右美托咪定组(Dex组).常规七氟醚诱导后,依次静脉注射芬太尼2-3μg/kg,丙泊酚2-3mg/kg,苯黄顺阿曲库铵0.1-0.2mg/kg后,行气管插管,以2％七氟醚、100％氧气维持麻醉.手术结束前0.5h,2组患者分别静脉泵入生理盐水或右美托咪定(0.5μg/kg).术毕记录生命体征、苏醒期躁动发生率及PAED评分.结果 右美托咪定用药对手术时间、麻醉时间、拔管时间、七氟醚用量无明显影响;右美托咪定可以有效降低术后躁动的发生,PAED评分显著下降,并可降低心率.结论 智障儿童全麻下齿科治疗中,使用右美托咪定可以降低术后躁动的发生率.