右美托咪啶复合七氟烷麻醉辅助利多卡因超声雾化用于婴幼儿无痛纤支镜检查的安全性和有效性观察

The efficacy and the safety of dexmedetomidine combined with sevoflurane anesthesia assisted lidocaine ultrasonic atomization for fiberoptic bronchoscopy in children

目的研究右美托咪啶复合七氟烷麻醉辅助利多卡因超声雾化在小儿纤支镜检查中的安全性和有效性。方法 40例患儿分为右美托咪啶复合七氟烷麻醉组（A组）和对照组（B组）各20例。检查前30分钟常规肌内注射阿托品0.01mg/kg,检查前10分钟均给予利多卡因4mg/kg超声雾化吸入。进入麻醉等待室后,给予咪达唑仑0.05mg/kg缓慢静推,麻醉诱导前10分钟,A组用微量泵10分钟内输注盐酸右美托咪啶1μg/kg,B组患者组给予10分钟总量为0.5ml/kg的生理盐水泵注。两组患儿均用丙泊酚2mg/kg,舒芬太尼0.1μg/kg缓慢静脉注射麻醉诱导,应用喉罩半紧闭循环回路自主吸入七氟烷维持麻醉。分别在入室时（T_0）、10分钟泵注完毕（T_1）、插入喉罩后（T_2）、纤支镜到达声门（T_3）、纤支镜到达气管隆嵴（T_4）、进入支气管（T_5）各时间点观察记录两组患儿呼吸、血压（BP）、心率（HR）、血氧饱和度（SPO2）,在T_2、T_3、T_4、T_5各时间点记录患儿呛咳、憋气、体动情况,并记录麻醉苏醒时间,术后躁动情况。结果 A组麻醉效果评价：优12例,良8例,优良率100%;B组优9例,良5例,可6例,优良率70%;差异有显著性。A组HR在T_1时间点较T_0时明显下降,余各时间点HR、BP、SPO_2与T_0比较差异无显著性。B组HR、BP在T_1T_5各时间点均较T0时明显升高,差异有显著性。SPO_2在T_2T_5较T_0时明显降低,差异有显著性。两组患儿在T_0时间点血流动力学平均值差异无显著性,在T_1T_5各时间点,A组HR、BP均较B组明显降低,差异有显著性,SPO_2平均值均高于对照组,差异有显著性。两组患儿术后苏醒时间差异无显著性;A组术后躁动发生率15%（3/20）,B组为60%（12/20）,差异有显著性。结论右美托咪啶复合七氟烷麻醉辅助利多卡因超声雾化用于婴幼儿无痛纤支镜检查安全、有效,检查时患儿生命体征平稳,纤支镜检查顺利进行,并能有效减少术后躁动的发生率。

Objective To investigate the efficacy and the safety of dexmedetomidine combined with sevoflurane anesthesia assisted lidocaine ultrasonic atomization for fiberoptic bronchoscopy in children. Method Forty patients,scheduled for elective fiberoptic bronchoscopy,were randomly divided into A group（ dexmedetomidine group） and B group（ control group）. Both two groups of children were administered ultrasonic atomizing inhalation with lidocaine 4mg / kg at 10 minutes before entering the anesthesia waiting room,followed by slow injection with midazolam0. 05 mg / kg before entering the operating room. The children were hold into the operation room after they were quiet. After that,in group A（ dexmedetomidine group）,dexmedetomidine 1μg / kg was infused intravenously（ with in 10 minutes）,while equal volume of normal saline was infused in group B（ control group）. Then propofol 2mg / kg and sufentanyl 0. 1μg / kg were injected slowly to all the children. The laryngeal masks were placed after consciousness were lost. Anesthesia was maintained with sevoflurane under spontaneous ventilation during the Fiberoptic bronchoscopy. Respiratory rate（ RR）,blood pressure（ BP）,heart rate（ HR） and oxygen saturation by pulse oximeter（SpO_2） were recorded at the time when entered the operation room（T_0）,after 10 minutes infusion（T_1） and laryngeal masks insertion（ T_2）,when the tip of fiberoptic bronchoscope reached the glottis（T_3） and carina（T_4）,into the bronchus（ T_5）. Bucking,breath holding and body movement were recorded at T_2,T_3,T_4 and T_5. The anesthesia recovery time and postoperative restlessness were also investigated. Result The HR in group A were significantly decreased（ P〈 0. 05） after infusion Dex compared with group B. Compared with group A at T_2,T_3,T_4 and T_5,incidence of bucking,breath holding,body movement and postoperative restlessness were significantly increased in group B（ P〈 0. 05）. Conclusion dexmedetomidine combined with sevoflurane anesthesia assisted lidocaine ultrasonic atomization for fiberoptic bronchoscopy in children was safe and effective. The fiberoptic bronchoscopy went smoothly and the vital signs of the children were stable during the operation time. Besides,the frequency of postoperative restlessness was decreased effectively.