右美托咪定对小儿扁桃体合并腺样体手术全麻苏醒期躁动的影响

Effect of dexmedetomidine infusion on post-operative agitation during general anesthesia induction and maintenance in pediatric adenotonsillectomy patients

目的观察右美托咪定对小儿扁桃体合并腺样体手术全麻苏醒期躁动的影响。方法择期行扁桃体腺样体手术的患儿80例,年龄3～13岁,体重12～42 kg,ASA分级Ⅰ～Ⅱ级,随机分为右美托咪定组（D组）和生理盐水对照组（C组）。麻醉诱导后右美托咪定组给予右美托咪定1μg·kg-1泵注10 min,继之以0.5μg·kg-1·h-1持续泵注至手术结束；对照组给予等容量生理盐水。两组患儿均在静吸复合气管内插管全麻下完成手术。记录两组患儿的手术时间和拔管时间；采用4分法评估并记录患儿手术后躁动情况,并记录出现躁动后需静注丙泊酚镇静的例数。结果两组患儿苏醒期躁动观察：D组较C组明显减少（P〈0.05）；躁动后处理比较：D组需给予丙泊酚镇静4例（10%）,C组需给予丙泊酚镇静13例（32.5%）（P〈0.05）。结论右美托咪定能明显降低全身麻醉手术后躁动的发生率,可安全地应用于儿科扁桃体合并腺样体住院手术患儿。

Objective To observe the effect of dexmedetomidine（Dex） infusion on post-operative agitation（POA） during general anesthesia induction and maintenance in pediatric adenotonsillectomy patients. Methods Eighty ASA Ⅰ ～ Ⅱ pediatric patients 3 ～ 13 years undergoing adenotonsillectomy,were randomly divided into two groups： the Dex group（ Group D） and the control group（ Group C）. Before tracheal intubation,patients received either 1. 0 μg·kg-1over 10 min followed by a maintenance 0. 5 μg·kg-1·h-1of Dex infusion（ Group D）（ n = 40） or the same volume saline infusion（ Group C）（ n = 40）. Mean arterial blood pressure（ MAP） and heart rate（ HR） were recorded. Post-operative agitation was evaluated using a 4-point scoring scale. A frequency for the patients with POD,as well as who received propofol to comfort were also recorded. Results MAP and HR were much more stable in Group D during surgery（ P 〈 0.05）. The incidence rate of POA in Group D was lower than that in Group C（ P 〈0. 05）. 10% in Group D and 32. 5% of children in Group C who experienced POA received propofol injection（ P 〈 0. 05）. Conclusion Dexmedetomidine reduces the incidence rate of POA underlying general anesthesia,which is securely evaluated for pediatric inpatient adenotonsillectomy.