右美托咪定对小儿扁桃体腺样体手术全凭静脉麻醉术后躁动的预防作用

Prevention effect of dexmedetomidine on TIVA postaneanethsthesia agitation in children with tonsillectomy and adenoidectomy

目的观察右美托咪定对小儿扁桃体腺样体手术全凭静脉麻醉术后躁动的预防作用。方法小儿扁桃体腺样体手术患者60例,ASAⅠ级,随机分为3组。A、B两组均为全凭静脉麻醉。A组：右美托咪定组,麻醉诱导后以0.4μg/（kg·h）泵入右美托咪定,持续20 min;B组无特殊处理;C组：全凭静脉麻醉复合七氟烷（2%~3%）吸入麻醉组。观察并记录术毕即刻、拔管即刻、拔管后5 min的平均动脉压、心率、血氧饱和度,观察并记录躁动发生情况、拔管时间、唤醒时间及离开手术室的时间。结果三组患儿各时间点血压差异无统计学意义。三组拔管即刻HR较术毕即刻升高（P〈0.05）;拔管即刻B组、C组高于A组（P〈0.05）。三组血氧饱和度差异无统计学意义。A组躁动发生率低于B组、C组（P〈0.05）;拔管时间高于B组、C组（P〈0.05）;三组唤醒时间差异无统计学意义（P〉0.05）;从术毕到离开手术室时间右美托咪定组与对照组差异无统计学意义。结论小剂量右美托咪定在一定程度上降低了拔管的应激反应,但不能完全抑制。右美托咪定可明显降低小儿扁桃体腺样体手术全凭静脉麻醉术后躁动的发生率,延长拔管时间,但不延长离开手术室的时间。

Objective To study the prevention effect of dexmedetomidine on TIVA post anethsthesia agitation in children with tonsillectomy and adenoidectomy.Methods 60 children with tonsillectomy and adenoidectomy（ASAⅠ） were randomly divided into 3 groups： group A（dexmedetomidine group）; group B（no special treatment）; group C（TIVA and sevoflurane inhalation anesthesia）.Group A was given dexmedetomidine 0.4 μg/（kg·h） after venous induction（lasted for 20 min）,while control group was given nothing.The MAP,HR,SpO2were recorded at the end of operation（t0）,extubation（t1）,5 min after extubation（t2）.The agitation case,extubation time,wake-up time and the time of discharge from operation room were recorded.Results There was no significant difference in MAP and SpO2among the 3 groups（P0.05）.The HR of the 3 groups at t1was higher than that at t0,and the HR in group B and group C was higher than that of group A（P0.05）.The incidence of agitation of group A was lower than those of group B and group C,and the extubation time was longer（P0.05）.No significant difference was found in wake-up time among the 3 groups（P0.05）.Conclusion Small dose of dexmedetomidine can decrease the stress,but cannot inhibit it totally.Dexmedetomidine can decrease the incidence of agitation in TIVA of children with tonsillectomy and adenoidectomy,increase the time to extubation,without increasing the time from the end of operation to discharge from operation room.