石美托咪定对小儿扁桃体切除术全麻拔管期血流动力学及苏醒质量的影响

Effects of dexmedetomidine on hemodynamics during extubation period and recovery quality after tonsillectomy in children

目的观察右美托咪定对小儿扁桃体切除术全麻拔管期血流动力学及苏醒质量的影响。方法择期行双侧扁桃体切除术患儿60例,随机分为两组,每组30例。麻醉诱导插管后,右美托咪定组给予右美托咪定0.5μg·kg^(-1),10 min泵完,对照组泵注等量氯化钠注射液。两组其他麻醉方法相同。监测患儿入室时(T_0)、术毕(T_1)、拔管时(T_2)、拔管后2 min(T_3)、拔管后5 min(T_4)、拔管后10 min(T_5)各时点的平均动脉压(MAP)和心率(HR),记录睁眼时间及拔管时间。记录术毕患儿恶心、呕吐情况,并评估患儿躁动发生率。结果T_0时,两组MAP和HR无显著差异(P>0.05)。T_1—T_5各时点右美托咪定组MAP和HR显著低于对照组(P<0.05)。两组睁眼时间及拔管时间无显著差异(P>0.05)。右美托咪定组发生术后躁动5例,恶心、呕吐3例,对照组分别为16例和10例,右美托咪定组躁动发生率及恶心、呕吐发生率均低于对照组(P<0.05)。结论右美托咪定能使小儿扁桃体切除术后拔管时血流动力学更加平稳,并有效减少术后躁动及恶心、呕吐的发生,且不影响麻醉苏醒时间。

AIM To investigate the effects of dexmedetomidine on hemodynamics during the extubation period and recovery quality after tonsillectomy in children. METHODS Sixty children scheduled for tonsillectomy were divided randomly into two groups： dexmedetomidine group and control group. Dexmedetomidine was given with 0.5 μg ·kg^-1 within 10 min following anesthesia induction in the dexmedetomidine group, while the same volume of normal saline was given in the control group. The other anesthesia methods of two groups were the same. The MAP and HR of the children were recorded when entering the operation room （T0）, at the end of surgery （T1）, being extubated （T2）, 2 minutes after being extubated （T3）, 5 minutes after being extubated （T4）, and 10 minutes after being extubated （Ts）. The eye-opening time and extubation time were recorded. The incidence of nausea, vomiting and emergence agitation were observed. RESULTS There weren＇ t significant difference in MAP and HR between two groups at To （P 〉 0.05）, while during TI - Ts the MAP and HR in the dexmedetomidine group were significantly lower than those of the control group （P 〈 0.05） . There was no significant difference in the eye- opening time and extubation time between two groups （P 〉 0.05） . The incidence of agitation （5 vs. 16） and incidence of nausea and vomiting （3 vs. 10） in the dexmedetomidine group were Rower significantly compared with the control group （P 〈 0.05）. CONCLUSION Dexmedetomidine can make children＇ s hemodynamic more stablely during the period of extubation, and decrease the incidence of agitation and incidence of nausea and vomiting, while not prolonging the recovery time.