右美托嘧啶在预防小儿Nuss手术苏醒期躁动的应用研究

摘要

Objective To observe Dexmedetomidine in the prevention of pediatric Nuss operation restlessness effect.Methods 60 patients underwent Nuss operation were randomly divided into Dexmedetomidine group ( D group) and Normal saline group ( N group ), with sevoflurane inhalation induction, intravenous remifentanil 2μg•kg-1,cisatracurium 0.15 mg•kg-1, D group was given the right search pyrimidine 1μg•kg-1, when the tracheal intubation the BIS is 60. Dexmedetomidine speed is 0.2μg•kg-1•h-1, 5 min operation before the end of the infusion was stopped;group N intravenous saline. After the operation all patients were extubated, analgesia pump into the recovery room observation 2 h. Recording with operation time, stopping time to awake, the right search pyrimidine injected into the anterior (T1), after injection of 5 min ( T2 ), 10 min ( T3 ), children awake (T4), 1 min after extubation ( T5 ), 10 min after extubation ( T6 ), 30 min after extubation ( T7 ). MAP, HR, SpO2 and irritability score, recording time is greater than the rate of 10 min restlessness. Results Compare D group with N group, T4~T6 group D MAP were significantly decreased, HR was decreased (P<0.05 );4 cases in D group (13%), 21 cases in N group ( 70%) a restless, was higher in group N than in group D ( P<0.01 ), N group required significantly higher than that in D group PCA number(P<0.01 ).Conclusion Nuss operation in pediatric anesthesia analepsia period of dexmedetomidine can produce sedative, analgesic and anxiolytic effects, decreased significantly after anesthesia pain, agitation and hemodynamic changes, and no increase in adverse reaction.%　　目的观察右美托嘧啶在预防小儿Nuss手术苏醒期躁动的效果。方法60例接受Nuss手术的患儿，随机分为右美托嘧啶组（D组）和生理盐水组（N组），采用七氟烷吸入诱导,静脉推注瑞芬太尼2μg•kg-1、顺式阿曲库铵0.15 mg•kg-1,D组给予右美托嘧啶1μg•kg-1，待BIS为60时行气管插管。术中右美托嘧啶维持速度为0.2μg•kg-1•h-1，手术结束前5 min停止输注；N组静注生理盐水。手术结束后所有患儿均拔管，接镇痛泵送入恢复室观察2 h。记录患儿的手术时间，停药至清醒时间，右美托嘧啶注入前(T1)、注射后5 min(T2)、10 min(T3)、患儿清醒时(T4)、拔管后1 min(T5)、拔管后10 min(T6)、拔管后30 min(T7)的MAP、HR、SPO2及烦躁评分，记录躁动时间大于10 min的发生率。结果 D组与N组比较，T4～T6时的D组MAP明显降低，HR明显减慢（P<0.05）；D组4例（13%）、N组21例（70%）有躁动，N组明显高于D组（P<0.01）,N组所需要PCA次数明显高于D组（P<0.01）。结论在小儿Nuss手术麻醉苏醒期右美托咪啶可以产生镇静、镇痛和抗焦虑作用，明显减少麻醉后疼痛、躁动及血流动力学变化，且不增加不良反应。