右美托咪定对保留自主呼吸七氟烷麻醉唇腭裂手术患儿苏醒期的影响

摘要

Objective To investigate the effects of single intravenous dexmedetomidine hydrochloride on the recovery of spontaneous breathing in chidren patients receiving chilopalatognathus surgery by inhalation anesthesia of sevoflurane. Methods Seventy-six children patients who underwent chilopalatognathus surgery in our hospital from August 2014 to August 2015 were randomly divided into two groups.The patients in observation group were treated by sevoflurane anesthesia with spontaneous respiration and single intravenous injection of dexmedetomidine hydrochloride during operation,however,the patients in control group were treated by sevoflurane anesthesia with spontaneous respiration and intravenous injection of equivalent 0.9% sodium chloride solution.The palinesthesia time,SAS scores,Ramsay scores,the concentration of end-tidal sevoflurane at different time points of anesthesia were observed and compared between two groups. Results There was significant difference in palinesthesia time between two groups(P<0.05),and there were significant differences in the levels of sevoflurane at the end of expiration on 10min,20min and 30min after injection of different agents between two groups(P<0.01). Moreover there were significant differences in heart rate, MAP, SpO2,the scores of restlessness after palinesthesia (PAED) and Ramsay scores between two groups (P<0.05 or P<0.01).Conclusion The application of dexmedetomidine hydrochloride injection in chidren patients receiving chilopalatognathus surgery with spontaneous breathing by sevoflurane anesthesia can keep hemodynamic stability at analepsia stage, increase sedative satisfaction rate,decrease effectively the incidence rate of restlessness at analepsia stage,thus,which is beneficial to surgical treatment of patients.%目的 研究单次静注右美托咪定对保留自主呼吸七氟烷麻醉唇腭裂手术患儿苏醒期的影响.方法 选取2014年8月至2015年8月进行唇腭裂手术的患儿76例,随机分为2组.观察组患儿在手术麻醉过程中采用保留自主呼吸七氟烷麻醉并且单词静脉注射右美托咪定,而对照组患儿在采用保留自主呼吸七氟烷麻醉的过程中注入等量的0.9%氯化钠溶液,对比2组患者的苏醒时间、SAS评分和Ramsay评分、麻醉过程不同时段其呼气末七氟醚的浓度以及手术完成后苏醒时心率等其他指标,记录数据进行分析与讨论.结果 2组患者的苏醒时间上发现2组患儿呼唤睁眼时间具有明显差异(t=3.52,P=0.01);2组患儿在麻醉过程中注射不同药剂后10 min后、20 min后和30 min后呼气末的七氟醚浓度其差异均具有统计学意义分别为(t=3.08,P=0.01)、(t=4.32,P=0.00)、(t=25,P=0.01);2组患儿手术完成后苏醒时各项指标的对比中心率(t=4.99,P=0.00),MAP(t=4.61,P=0.00),SpO2(t=2.76,P=0.01)差异有统计学意义;2组患儿的Ramsay评分各分数段患儿对比(χ2=11.82,P=0.03),苏醒后躁动PAED评分比较(t=6.27,P=0.00)均具有统计学意义.结论 使用右美托咪定对保留自主呼吸七氟醚麻醉唇腭裂手术患儿能够保持苏醒期血流动力学的稳定性,提高苏醒期时患儿的镇静满意率,有效减少苏醒期躁动的发生率,对患儿的手术治疗有着积极作用.