右美托咪定对脑瘫患儿七氟醚麻醉苏醒期躁动的影响

Effect of dexmedetomidine on emergence agitation following sevoflurane anesthesia in children with cerebral palsy

目的探讨右美托咪定对脑瘫患儿七氟醚麻醉苏醒期躁动的影响。方法择期拟行肌力肌张力调整术的脑瘫患儿50例，ASA分级I或Ⅱ级，年龄2～12岁，性别不限。采用随机数字表法，将其分为2组（n=25）：对照组（C组）和右美托咪定组（D组）。D组麻醉诱导后经15min静脉输注右美托咪定0．5μg／kg，C组给予等容量生理盐水，给药结束后开始手术，术中吸入2％～4％七氟醚维持麻醉，维持BIS值45—60。于右美托咪定给药前（T1）、切皮时（T2）记录HR、SBP和DBP，记录拔管时间、苏醒时间和麻醉期间七氟醚用量，并于T1、T2、术毕（T1）时记录呼气末七氟醚浓度；记录术中心血管不良事件及苏醒期躁动发生情况，并采用小儿苏醒期烦躁量表（PAED）评价躁动程度；于T1、T、T3管时（T4）采集外周静脉血样，测定血糖水平和血清皮质醇浓度。结果与C组比较，D组苏醒时间和拨管时间明显缩短，七氟醚用量、T2和T3时呼气末七氟醚浓度、PAED评分、躁动发生率降低，T4时血糖和血清皮质醇浓度降低（P〈0．05或0．01），2组心动过缓发生率以及各时点HR、SBP和DBP比较差异无统计学意义（P〉0．05）。结论右美托咪定可降低脑瘫患儿七氟醚麻醉苏醒期躁动的发生和程度。

Objective To investigate the effect of dexmedetomidine on emergence agitation （EA） following sevoflurane anesthesia in children with cerebral palsy. Methods Fifty ASA physical status I or II children with cerebral palsy of both sexes, aged 2-12 yr, scheduled for elective muscle strength muscle tension adjustment method, were randomly allocated into 2 groups （n = 25 each）： control group （group C） and dexmedetomidine group （group D）. Anesthesia was induced with iv injection of sufentanil 0.3 μg/kg, cisatracufium 0.15 mg/kg, and propofol 1.5 mg/kg. The patients were tracheal intubated and mechanically ventilated. Dexmedetomidine 0.5 μg/kg was intravenously infused over 15 min after induction of anesthesia in group D and the equal volume of normal saline was given in group C. The operation was begun at the end of administration. Anesthesia was maintained with inhalation of 2%-4% sevoflurane and the concentration was adjusted to achieve a target BIS value of 45-60. The heart rate, systolic blood pressure and diastolic blood pressure were recorded before infusion of dexmedetomidine （T1） and at skin incision （T2）. The extubation time, emergence time and consumption of sevoflurane were also recorded. The end-tidal sevoflurane concentration was recorded at T1, T2, and the end of operation （T3 ）. The adverse cardiovascular events and occurrence of EA were also recorded. The degree of EA was assessed using the Pediatric Anesthesia Emergence Delirium （PAED） scale. The peripheral venous blood samples were collected at T1, T2, T3 and extubation （T4） for determination of the blood glucose level and serum cortisol concentration. Results Compared with group C, the emergence time and extubation time were significantly shortened, and the consumption of sevoflurane, end-tidal sevoflurane concentrations at T2 and T3 , PAED ＂cores, incidence of agitation, and the ＂blood glucose level and serum cortisol concentration at T4 were significantly decreased in group D （P 〈 0.05 or 0.01 ）. There was no significant difference in the incidence of bradycardia or heart rate, systolic blood pressure and diastolic blood pressure at each time point between the two groups （ P 〉 0.05）. Conclusion Dexmedetomidine can decrease the development and degree of EA following sevoflurane anesthesia in children with cerebral palsy.