右美托咪定联合咪达唑仑术前滴鼻在小儿斜疝手术麻醉中的应用

Application of Intranasal Dexmedetomidine Combined with Midazolam Premedication in the Anesthesia of Pediatric Indirect Hernia Operation

目的：探讨右美托咪定联合咪达唑仑术前滴鼻在d,JL斜疝手术基础麻醉中的有效性及可行性。方法：将60例1—3岁拟行疝气手术的小儿随机分为3组。麻醉方法均为基础麻醉诱导患儿入睡，抱人手术室后实施不插管全凭吸人麻醉，术中辅助局麻，手术时间均在1h以内。麻醉诱导前30min，A组给予右美托咪定1μg／kg＋咪达唑仑0．2mg／kg滴鼻，B组以右美托咪定1μg/kg滴鼻，C组以咪达唑仑0．2mg／kg滴鼻。观察并记录患儿的入睡时间、人室后Ramsay镇静评分、诱导时对麻醉面罩的接受程度、苏醒时间、苏醒期躁动评分。结果：A组入睡时间（12．31±3．21）min明显小于B组（23．55±3．72）min和C组（19．23±3．32）min（P〈0．05）。A组镇静满意率和面罩接受率显著高于B组和C组（P〈0．05）。同C组比较，A组和B组躁动发生率明显降低（P〈0．05），苏醒时间元差异（P〉0．05）。结论：在4,JL麻醉前给予右美托咪定1μ/kg＋咪达唑仑0．2mg／kg滴鼻可以产生良好的镇静效果，缩短吸入诱导时间，预防苏醒期躁动，并且不延长患儿苏醒时间。

Objective To investigate the efficacy and feasibility of intranasal dexmedetomidine（DM） combined with midazo- lam in the basic pre-anesthesia in the pediatric indirect hernia operation. Methods Sixty children from 1 to 3 years old un- dergoing hernia surgery were randomly divided into group A, B and C （n = 20）. All patients were induced into sleep through basic anesthesia. Then they were carried into operation room, followed by the sevoflurane inhalation anesthesia without intu- bation. Assistant local anesthesia were used when necessary during operation. Operation would be finished within 1 hour. At 30 minutes before operation, the children were i ntranasal administration with DM（ 1 μg/kg） combined midazolam（0.2 mg/ kg） in group A,DM（1μ/kg） in group B,midazolam（0.2 mg/kg） in group C. The time to fall asleep,Ramsay sedation scores, aeceptive degree of mask, time to palinesthesia, postoperative agitation scores of patients were recorded. Results The time to fall asleep of patients in group A [ （ 12.31 ±3.21 ） rain ] was significantly shorter than that of group B [ （23.55 ± 3. 72） mini and C[ （ 19.23 ± 3.32） mini, （ P 〈 0.05）. The degrees of sedative satisfaction and mask acception in group A were significantly higher than that of group B and C （ P 〈 0.05）. Compared with group C, the incidence of agitation in group A and B were significantly lower（ P 〈 0.05 ）, the times to palinesthesia had no significant difference（ P 〉 0.05 ）. Conclu- sion Intranasal administration with 1 μ/kg DM and 0.2 mg/kg midazolam as premedication before children anesthesia in- duction could provide a ideal sedation effect, reduce the time to fall asleep and the incidence of agitation without delaying the time to palinesthesia.