右美托咪定与丙泊酚静脉麻醉在小儿气道异物取出术中的应用比较

Clinical comparison of dexmedetomidine and propofol in pediatric airway foreign body removal surgery

摘要：目的观察右关托咪定用于小儿气道异物取出术的临床镇静效果及安全性，并与丙泊酚静脉麻醉效果进行比较。方法2012年11月-2013年3月于该院行气管支气管异物取出术的患儿60例，年龄10个月～3岁，ASAⅠ～Ⅱ级，随机平均分为右美托咪定组（D组）和丙泊酚组（P组），每组30例。患儿入室前静脉注射氯胺酮1～2mg／kg，阿托品0．02mg／kg，地塞米松（）．15mg／kg，入室后持续监测心率（HR）、平均动脉压（MAP）、呼吸频率（RR）、脉搏氧饱和度（SpO：），脑电双频谱监测仪监测BIS值。D组、P组分别给予右关托咪定1μg／kg，丙泊酚2mg／kg持续静脉泵注10min，继而分别以右美托咪定0．8～2．0μg／（kg·h），丙泊酚1～2mg／（kg·h）维持麻醉，观察并记录入室时（T0）、置入支气管镜前即刻（T1）、置入支气管镜后即刻（T：）、退出支气管镜后即刻（T3）的HR、MAP、RR、SpO，和BIS值，手术用时（即置入支气管镜至退出支气管镜所用时间）、患儿苏醒时间以及置入支气管镜时、术中术后患儿呛咳、体动、屏气、脉搏氧饱和度下降、喉或支气管痉挛等并发症。结果与T0、相比，两组患儿在T1时刻HR、MAP、RR和BIS有所降低（P〈0．05），但均在正常范围内；术中D组患儿MAP、RR和SpO，高于P组（P〈0．05）；两组患儿术中BIS值、术后苏醒时间差异无显著性（P〉0．05）；D组术中及术后呛咳、体动、屏气、脉搏氧饱和度下降、喉或支气管痉挛等并发症的发生率显著低于P组（P〈0．05）。结论在等效镇静剂量下，右美托咪定对患儿呼吸及术后苏醒影响轻微，较丙泊酚可更加有效地维持患儿血流动力学稳定，故该剂量下可安全用于小儿气道异物取出术。

[ Objective ] To determine the clinical sedative efficacy and safety of dexmedetomidine and make a comparison with propofol in pediatric airway foreign body removal surgery. [Methods] Between November 2012 and March 2013, 60 pediatric patients （aged 10 months to 3-year-old, ASAⅠ-Ⅱ ） who underwent airway foreign body removal surgery were included. The patients were randomly assigned to one of 2 groups （n =30 eaeh）：group D for dexmedetomidine and group P for propofol. All patients were intravenous ketamine 1-2 mg/kg, atropine 0.02 mg/kg and dexamethasone 0.15 mg/kg before burglary. After the burglary, continuous monitoring of heart rate （HR）, mean arterial pressure（MAP）, respiratory rate （RR） and pulse oxygen saturation （SpO2）, bispectral index （BIS）. The patients were randomly assigned to receive either dexmedetomidine 1 p,g/kg （group D） or propofol 2 mg/kg （group P） 10 min- utes before the induction of anesthesia, then dexmedetomidine 0.8-2.0 p,g/（kg＇h） or propofol 1-2 mg/（kg＇h） to main- tain anesthesia. HR, MAP, RR and SpO2 were measured and noted after burglary （To）, the moment before the placing bronchoscopy（Tt）, the moment after placing of bronehoscopy（T2）, the moment after exiting bronchoscopy （T3）. The sur-gical time （from the placement of the bronchoscope to the exit of it）, recovery time and cough, body movement, hold breath, pulse oxygen saturation decreased, throat or bronchial spasms and other complications were recorded when placed bronchoscope, intraoperative and postoperative. [ Results ] Compared with TO, the two groups of patients＂ HR, MAP, RR, BIS decreased at T~ （P 〈0.05）, but they were all within the normal range; the MAP,RR, SpO2 in group D were higher than those of group P intraoperative （P 〈0.05）; the BIS and recovery time of the 2 groups had no signifi- cant difference （P 〉0.05）, respectively. The incidence of complications including cough, body movement, hold breath, pulse oxygen saturation decreased, throat or bronchial spasms and so on were higher in group P than group D （P 〈 0.05）. [ Conclusion] Under the equivalent sedation dose, dexmedetomidine has minimal impact on the respiratory and postoperative awake, which can be more effective in maintaining hemodynamic stability in pediatric patients than propofol. Therefore, in this dose dexmedetomidine can be used safely in pediatric airway foreign body removal surgery.