小剂量右旋美托咪定对鼾症患儿七氟醚麻醉苏醒期的影响

摘要

目的：观察七氟醚麻醉诱导前小剂量右旋美托咪定对鼾症患儿苏醒期的影响。方法因鼾症需在全麻行扁桃体腺样体摘除术患儿40例，按双盲随机原则分为实验组和对照组，每组20例；实验组患儿在麻醉诱导前10min给予右旋美托咪定0．3μg/kg，对照组输入林格氏液。记录患儿入室后右旋美托咪定注射前（T0）、注射后5min（T1）、注射后10min（T2）、患儿清醒时（T3）、拔管后1min（T4）、拔管后5min（T5）、拔管后10min（T6）的血氧饱和度（SPO2）、收缩压（SBP）、舒张压（DBP）、呼吸（RR）和心率（HR），并于拔管后各时点对患儿进行躁动评分和Ramsay镇静评分。结果两组患儿DBP、RR和SPO2组间和组内比较差异均无统计学意义（P＞0．05）；两组SBP、HR比较，差异有统计学意义（P＜0．05），T3～T5时点对照组SBP明显高于实验组，实验组SBP升高幅度明显小于对照组（P＜0．05）；对照组T3～T6时点HR明显快于实验组（P＜0．05）。两组躁动评分、Ramsay镇静评分比较，差异均有统计学意义（P＜0．05），对照组T3～T6时点躁动评分明显高于实验组；对照组T3～T6时点镇静评分明显低于实验组（P＜0．05）。结论小剂量右旋美托咪定可为鼾症手术患儿麻醉苏醒期提供良好的镇静效应，较好地抑制了患儿苏醒期躁动及拔管反应，使血流动力学更稳定。%Objective To observe the effects of low-dose dexmedetomidine before anesthesia induced with sevoflurane on snoring children during recovery period of anesthesia .Methods Forty children undergoing tonsil and adenoid enucleation under general anesthesia were enrolled in a double-blind study,and they were randomly divided into experimental group and control group ,20 cases in each group .The children in the experimental group received intravenous dexmedetomidine of 0.3 μg/kg 10 minutes before induction of anesthesia ,while in the control group were injected with Ringer′s solution.Peripheral oxygen saturation (SpO2),systolic blood pressure (SBP),diastolic blood pressure (DBP), respiratory rate(RR) and heart rate(HR) were monitored and recorded at 7 time points which were before dexmedetomidine infusion(T0),5 minutes after infusion(T1),10 minutes after infusion(T2),immediately awaking time of children ( T3 ) ,1 minute after extubation ( T4 ) ,5 minutes after extubation ( T5 ) ,10 minutes after intubation ( T6 ) .The agitation and Ramsay sedation scores of the children were assessed at each time point after extubation .Results There was no significant difference in DBP,RR and SpO2 between two groups(P>0.05).SBP and HR showed a significant difference between two groups(P<0.05),SBP in the control group was significantly higher than that in the experimental group at the time points of T3 ,T4 and T5 ,and the increase of SBP in the experimental group was significantly less than that in the control group(P<0.05).HR in the control group was more than that in the experimental group at the time points of T 3 ,T4 ,T5 and T6 (P<0.05).There was significant difference in agitation and Ramsay sedation scores between two groups (P<0.05),the agitation scores(T3,T4,T5 and T6) in the control group were significantly higher than those in the experimental group (P<0.05),and the Ramsay sedation scores (T3 ,T4 ,T5 and T6 )in the control group were significantly lower than those in the experimental group(P<0.05).Conclusion Low-dose dexmedetomidine can provide good sedative effects for snoring children undergoing operation during recovery period of anesthesia ,it can inhibit the children′s agitation and reaction of extubation better during recovery period of anesthesia as well as make the hemodynamics stable .