右美托咪定对小儿全凭静脉麻醉苏醒期躁动的影响

The effects of dexmedetomidine on emergence delirium in pediatric under total intravenous anesthesia

目的 观察右美托咪定预防小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期躁动的作用.方法 将60例全凭静脉麻醉下行择期扁桃体腺样体切除术患儿,随机分为实验组（A组）与对照组（B组）,诱导后分别持续静脉泵入右美托咪定每小时0.2 μg/kg和等容量的生理盐水至手术结束.记录患儿手术时间、停药至清醒时间、恢复室滞留时间、到达恢复室即刻改良Aldrete评分、进入恢复室后30 min内根据儿童麻醉后躁动评分（PAED）和改良加拿大东安大略儿童医院疼痛评分量表（m-CHEOPS）,每5 min对患儿进行躁动和疼痛评分,所得最高值作为监测有效值.结果 实验组与对照组比较,停药至清醒时间、Aldrete评分及恢复室滞留时间的差异无统计学意义（P＞0.05）,PAED评分E组[（9.4±1.8）分]显著低于C组[（13.8±2.2）分,P＜0.05],疼痛评分E组[（3.8±0.6）分]显著低于C组[（4.8±0.8）分,P＜0.05].结论 右美托咪定可在一定程度上预防小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期躁动的发生.

Objective To observe the effects of dexmedetomidine on emergence delirium in pediatric adenotonsillectomy under total intravenous anesthesia （TIVA）.Methods 60 children undergoing adenotonsillectomy under TIVA were randomly divided into experimental group （group A） and control group （group B）.Anesthesia was induced than dexmedetomidine was infused at the rate of 0.2 μg/kg.h in group E and sodium chloride was infused at the same volume in group C after induction.Record the time of operation,drug withdrawal to conscious,retention time of recovery room,and the modified Aldrete score of reaching recovery room,according to the Pediatric Anesthesia Emergence Delirium to mark the delirium of the patient in the future 30 minutes per 5 minutes,the highest score is used to effective value.and at the same time,mark the degree of pain according to the modified Children＇ s Hospital of Eastern Ontario Pain Scale.Results There was no statistical significance in comparation with group C and group E,the time of drug withdrawal to conscious,retention time of recovery room,and the modified Aldrete score of reaching recovery room （P ＞ 0.05）.Pediatric anesthesia emergence delirium （PAED） of group E （9.4 ± 1.8） was significantly lower than group C （13.8 ± 2.2） （P ＜ 0.05）,pain of group E （3.8 ± 0.6） was significantly lower than group C （4.8 ± 0.8） （P ＜ 0.05）.Conclusion Dexmedetomidine can decrease the incidence rate of emergence delirium in pediatric adenotonsillectomy under TIVA.