右美托咪啶用于小儿全麻苏醒期躁动的临床观察

Clinical observation the effect of dexmedetomidine on emergence agitation after sevoflurane general anesthesia in pediatrics

目的:观察右美托咪啶治疗不同年龄小儿七氟烷全麻后苏醒期躁动的效果及安全性。方法:选择七氟烷全麻术后患儿80例,根据年龄分为Ⅰ组(3～6岁)和Ⅱ组(7～12岁),每个年龄段组再随机分为2组:右美托咪啶组(MⅠ组、MⅡ组,n=20)和对照组(CⅠ组、CⅡ组,n=20)。气管插管后M组静脉泵注右美托咪啶1μg.kg-1,C组静脉泵注等容积生理盐水。观察给药前5 min(T0)、给药5 min(T1)、给药后5(T2),15(T3),30(T4),60 min(T5)及拔管前停七氟烷时(T6)血流动力学、最低肺泡有效浓度(MAC)和呼出七氟烷浓度变化,记录麻醉恢复室(PACU)躁动发生率和躁动程度、苏醒时间、PACU停留时间、术后4 h及8 h Ramsay镇静评分,记录术后呼吸抑制、嗜睡、恶心呕吐、寒颤、皮肤瘙痒等不良反应发生情况。结果:与C组相比,M组T1时点SBP变化有统计学差异(P<0.05),术后躁动发生率显著下降(P<0.05);各时点MAC和呼出七氟烷浓度差异有统计学意义(P<0.05);术后4 h Ramsay镇静评分增加(P<0.01);术后发生嗜睡明显较多(P<0.05)。与C组相比,M组苏醒时间延长(P<0.05),PACU停留时间显著延长(P<0.01)。结论:右美托咪啶(1μg.kg-1)能安全、有效地治疗小儿全麻苏醒期躁动,同时能减少术中麻醉药用量。

ABSTRACT：OBJECTIVE To investigate the efficacy and safety of dexrnedetomidine on emergence agitation after sevoflurane general anesthesia in pediatric patients. METHODS 80 pediatric patients after sevoflurane general anesthesia were divided into two age groups, with 40 in each group, group I aged 3 - 6 years, group H aged 7 - 12 years, each group was randomly divided into two sub groups： Dexmedetomidine group （group M I , group M]][ , n = 20） and control group （group C I , group CII , n = 20）. The patients in group M were intravenously injected dexmedetomidine 1 t.tg.kg-~ after tracheal intubation, and patients in group C were intravenously injected isometric normal saline solution within 10 rains. SBP, DBP, HR, MAC and concentra- tion of exhaled sevoflurane were recorded 5 min before injected（T, ）and injected in 5 rain（T, ）, at 5 min（T2 ）, 15 min（T3）, 30 min（T4）, 60 min （Ts）after injection, cessation of sevoflurane inhalation（T6 ）. The incidence and degree of emergence agita- tion, the recovery time, the time of staying in postanesthesia care unit （PACU）and 4 h or 8 h Ramsay scores after operation were recorded. The incidence of adverse reactions such respiratory depression, lethargy, shivering, nausea and vomiting and so on were recorded. RESULTS SBP at T1 points in group M increased significantly compared with those in group C at T1 point （P〈0. 05） ;The incidence of emergence agitation in group M was significantly lower than in group C（P〈0. 05） ;there were significant differences in MAC and concentration of exhaled sevoflurane among groups M and groups C （P〈0. 05） ; The 4 h Ramsay scores after operation in group M was significantly higer than that in group C（P〈0. 05） ; The incidence of lethargy in group M was much more than in group C（P〈0. 05）; The recovery time in group M was much longer than that in group C（P〈0. 05）. The time of staying in PACU in group M Ⅱ was much longer than that in group C Ⅱ （P〈0. 01 ）. CONCLUNION It was safe and feasible to give dexmedetomidine （1 μg·kg^-1） for reducing emergence agitation after sevoflurane general anesthesia in pediatric patients and also reducing the amount of anesthetic.