右美托咪定减轻小儿瘢痕整形术后苏醒期气道及心血管不良反应的临床研究

Dexmedetomidine attenuates respiratory/cardiovascular depression of postoperative emergence in children undergoing plastic surgery:a clinical report of 60 cases

目的研究盐酸右美托咪定减轻小儿瘢痕整形术后麻醉苏醒期气道、循环反射的可行性。方法筛选我院整形科2011年4月至2012年3月收治的60名5-7岁瘢痕挛缩畸形患儿,其中女性21例,男性39例。全麻下行瘢痕切除及皮片移植术,术毕前40 min随机双盲静脉泵注0.5μg/kg盐酸右美托咪定注射液(n=30)或生理盐水安慰剂(n=30)10 min。对比2组麻醉结束后自主呼吸恢复时间、拔管时间、拔管后呛咳次数、寒战反应、Ramsay评分,记录拔管前、中、后患儿心率、血压、脉搏氧饱和度。结果盐酸右美托咪定组和生理盐水对照组的呛咳评分中位数分别为1(1-3)和2(1-4)(P<0.05),寒战发生率分别为2例和17例(P<0.05)。盐酸右美托咪定组和生理盐水对照组Ramsay评分分别是2-4分和1-2分。2组患者拔管时心率、血压有所上升,生理盐水对照组与盐酸右美托咪定组相比升高显著(P<0.05)。2组患者清醒时间和拔管时间基本一致,患者拔管后脉搏氧饱和度都有所下降。结论小儿整形手术结束前,单次注射盐酸右美托咪定注射液可减轻气管拔管时的气道和循环反射,减轻术后寒颤反应并具有术后镇静的作用。

Objective To investigate the feasibility that dexmedetomidine attenuates the airway and circulatory reflexes during postoperative stage of analepsia in children undergoing plastic surgery.Methods Sixty children with cicatricial contracture deformities were treated by scar resection and skin grafting under general anesthesia in our hospital between April 2011 and March 2012 were enrolled in this study.They were 21 females and 39 males,aged 5 to 7 years old.In 40 min before the end of surgery,they were randomly assigned to receive either dexmedetomidine（0.5 μg / kg,group D,n = 30） or placebo（normal saline of same volume,group P,n = 30） intravenously over 10 min.The time of autonomous respiration recovery and tracheal extubation,and the number of coughs after extubation,as well as shivering reaction and Ramsay scores were compared between 2 groups.Heart rate（HR）,blood pressure（BP） and peripheral oxygen saturation were recorded before,during and after tracheal extubation.Results Median coughing scores were 1（ranging from 1 to 3） in group D,and 2（ranging from 1 to 4） in group P respectively（P 0.05）.Shivering was found in 2 cases in group D and in 17 cases in group P respectively（P 0.05）.Ramsay scores were 2 to 4 in group D and 1 to 2 in group P.HR and BP increased at extubation in both groups,but the increase was less significantly in group D（P 0.05）.The time from tracheal extubation and emergence from anesthesia were similar in both groups.Peripheral oxygen saturation was reduced after extubation in both groups.Conclusion A single-dose bolus injection of dexmedetomidine before the end of children plastic surgery attenuates airway and circulatory reflexes during extubation and postoperative shivering,and mediates sedative properties.