全麻诱导前应用右美托咪啶对腺样体切除术儿童苏醒期应激反应的影响

Effects of Dexmedetomidine Used before Anesthesia Induction in Reducing Stress Reaction during Recovery on Children Receiving Adenoidectomy after General Anesthesia

【目的】探讨全麻诱导前应用右美托咪啶对腺样体切除术小儿全麻恢复期应激反应的影响。【方法】按照完全随机法,将80例经口内镜下腺样体切除术患儿分为对照组(C组)和右美托咪啶组(D组),每组40例。右美托咪啶(0.5μg.kg-1)稀释到20 mL,于麻醉诱导前开始微量泵注,20 min注射完毕,对照组只注射等量生理盐水。观察两组患儿麻醉诱导期和术中血液动力学变化;术毕患儿均入复苏室,观察两组患儿术后全麻恢复期循环、苏醒情况,躁动评分与发生率,复苏室停留时间及术后相关并发症等。【结果】在麻醉诱导期和术中两组患儿血液动力学均稳定(P>0.05);在麻醉恢复期,D组患儿平均心率和动脉压与对照组比较更为平稳(P<0.05);右美托咪啶组患儿拔管前后躁动发生率及评分明显低于对照组,差异有统计学意义(P<0.05);术后疼痛评分显著低于对照组(P<0.05);患儿苏醒时间、拔管时间及复苏室停留时间与对照组无差异;对照组有3例术后渗血渗液较多,经后鼻孔填塞2 d后正常,2组均无误吸发生。【结论】右美托咪啶能减轻儿童腺样体切除术后全麻恢复期应激反应,可减轻恢复期工作量。

[Objective] To investigate effects of dexmedetomidine used before anesthesia induction in reducing stress reaction during recovery on children receiving adenoidectomy after general anesthesia. [ Methods] A total of 80 pediatric patients receiving adenoideetomy were randomly allocated into 2 groups： The control group （group C, n = 40） and the dexmedetomidine group （group D, n = 40）. When anesthesia induction was administrated, normal saline 20 mL or dexmedetomidine 0.5 μg/kg diluted to 20 mL was intravenously infused in 20 minutes. To observe hemodynamic changes in the two groups during anesthesia induction and operation. All pediatric patients were admitted to recovery room after operation. Heart rate, blood pressure were recorded. The time of recovery, extubation and stay in recovery room were recorded. Emergence agitation, bucking and other complications after surgery were observed. [ Results ] Hemodynamic changes in two groups during anesthesia induction and operation are stable. During recovery changes in heart rate and blood pressure of patients in group D were stable than that in group C （P 〈 0.05）. The accident rate and score of agitation of patients in group D were lower than that in group C （P 〈 0.05）. The pain scores in group D was lower than that in group C （P 〈 0.05）. There were no differences in the time of recovery, extubation and stay in recovery room. Three cases in group C have errhysis and need to stuff nostril. [ Conclusion ] Dexmedetomidine is effective in reducing stress reaction during recovery after general anesthesia in pediatric patients receiving adenoidectomy. As a result, nuring care is simplified.