不同剂量右美托咪定在脑瘫患儿选择性腰骶部脊神经后根切断术中的应用

摘要

Objective To explore the anaesthetic effects and evoked electromyogram results of different doses of dexmedetomidine in the surgery of selective posterior lumbar rhizotomy for the treatment of mixed dystonia and spasticity in children with cerebral palsy.Methods There were 60 cases of mixed dystonia and spasticity children with cerebral palsy underwent selective posterior lumbar rhizotomy from February 2015 to March 2016 in our hospital.According to random number table,all the 60 cases were divided into two groups,with 30 cases for each.Two groups of children were given electrophysiological monitoring during operation,in which group A was given 0.5 μg/(kg · min) dexmedetomidine by intravenous infusion,and group B was given 1.0 μg/(kg · min).It was compared respectively between the two groups of operation time,anesthesia time,waking hours,EEMG latency and amplitude of retention rate,mean arterial pressure,heart rate,SpO2 and adverse reactions.Results There was no difference of operation time,anesthesia time and the waking hours (P ＞ 0.05).There was no difference of the EEMG latency and amplitude of retention rate before and after the dexmedetomidine injection between the two groups (P ＞ 0.05).The mean arterial pressure and heart rates of group B was (60.5 ± 5.1) mmHg and (72.3 ± 10.1) times/minute respectively,which were significantly lower than (63.8 ±6.6) mmHg and (80.6-± 12.5) times/min of group A.The differences were statistically significant (all P ＜ 0.05).There was no significant difference of the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusions It may be the better dose of 0.5 μg/(kg · min) of dexmedetomidine in elective posterior lumbar rhizotomy for the treatment of mixed dystonia and spasticity in children with cerebral palsy for more advantages of safety and efficacy.%目的 探讨脑瘫患儿在选择性腰骶部脊神经后根切断术中不同剂量右美托咪定的使用效果及肌电图检测结果. 方法 选取2015年2月至2016年3月我院行选择性腰骶部脊神经后根切断术治疗的脑瘫患儿60例,根据随机数字表法分为A组与B组各30例.两组患儿均给予电生理监护仪监护,其中A组右美托咪定静脉输注的剂量为0.5 μg/(kg·min),B组右美托咪定静脉输注的剂量为1.0 μg/(kg·min).分别比较两组手术时间、麻醉时间、清醒时间,用药前后患儿患儿神经根诱发肌电图(evoked electromyogram,EEMG)的潜伏期以及振幅保留率,平均动脉压、心率、血氧饱和度以及不良反应. 结果 两组患儿手术时间、麻醉时间、清醒时间比较差异均无统计学意义(P＞0.05).用药前后A组EEMG潜伏期以及振幅保留率与B组相比,差异均无统计学意义(P＞0.05).用药后B组平均动脉压以及心率分别为(60.5-5.1) mmHg、(72.3 ±10.1)次/min,均显著低于A组的(63.8 ±6.6)mmHg、(80.6±12.5)次/min.用药后两组不良反应发生率比较差异无统计学意义(P＞0.05). 结论 在选择性腰骶部脊神经后根切断术中给予脑瘫患儿0.5μg/(kg·min)剂量的右美托咪定具有更好的安全性.