右美托咪定在小儿扁桃体切除手术中的临床观察

Clinic observation of Dexmedetomidine in the pediatric tonsil surgery

目的观察小儿扁桃体切除手术中使用右美托咪定后,对患儿拔管期血流动力学和麻醉苏醒时间的影响。方法 40例ASAⅠ级择期行扁桃体切除手术的小儿患者,年龄3-10岁,手术时间均小于1 h,将其随机分成右美托咪定组（D组,n=20）和对照组（N组,n=20）,常规全麻诱导气管插管后1 min,D组泵注右美托咪定（1μg/kg）10 min后开始手术,N组泵注同样剂量生理盐水10 min后开始手术。术中用七氟醚吸入维持麻醉,根据BIS值（40-60）调整七氟醚浓度,手术结束时停用七氟醚。观察记录入室时（T0）、手术结束时（T1）,气管拔管时（T2）、气管拔管后1 min（T3）、气管拔管后3 min（T4）、离开手术室时（T5）6个时间点的平均动脉压（MAP）、心率（HR）,记录D组和N组的麻醉苏醒时间（即停止麻醉药到患儿离开手术室的时间）。术后记录两组患儿苏醒后的躁动评分,记录躁动持续时间大于15 min的发生率。结果 D组患儿拔管期的MAP和HR波动比N组小,术中使用七氟醚的浓度比N组小,差异均有统计学意义（均P〈0.05）,术后躁动的发生率（25%）比N组（60%）低（P〈0.05）。两组患儿的麻醉苏醒时间比较,差异无统计学意义（P〉0.05）。结论右美托咪定可使患儿拔管期血流动力学更平稳,躁动发生率低,而且不影响麻醉苏醒时间。

Objective To observe the effects of Dexmedetomidine on children＇s hemodynamic when pulling out the endotracheal tube and the revive time of anesthesia during the pediatric tonsil surgery.Methods 40 children（3-10 years old）（ASAⅠ） undergoing selective tonsil surgery were randomly divided into two groups： Dexmedetomidine group（group D,n = 20） and control group（group N,n = 20）,the operation time was less than 1 hour.1 minute after conventional induction of general and tracheal intubation,the children in group D pumped injection Dexmedetomidine（1 μg/kg） during 10 minutes before starting the surgery,and the children in group N pumped injection the same dosage of physiological saline at the same way.After being intubated successfully,they received Sevoflurane by inhalation.Sevoflurane concentration was adjusted by BIS（40-60）.Sevoflurane ceased at the end of surgery.The MAP and HR of the children were recorded when entering the operation room（T0）,at the end of surgery（T1）,being extubated（T2）,1 minute after being extubated（T3）,3 minutes after being extubated（T4）,leaving the operation room（T5）.The recovery time of anesthesia and the restless score were counted after surgery.The incidence of restless for more than 15 min was recorded.Results The MAP and HR of children in group D were more smoothly than those of group N during the period of being extubated,and Sevoflurane concentration was lower than that of group N（all P〈0.05）,the incidence of restless（25%） were lower than group N（60%）（P〈0.05）.There was no significant difference in the recovery time of anesthesia of the two groups（P〈0.05）.Conclusion Dexmedetomidine may make children＇s hemodynamic more smoothly when pulling out the endotracheal tube,and reduce the incidence of restless,while not prolonging the recovery time from anesthesia.