右美托咪定对小儿全麻术后拔管期应激反应的影响

Effects of dexmedetomidine on stress reaction during extubation period in children's general anesthesia

目的:探讨右美托咪定对小儿全麻术后拔管期应激反应的影响。方法:60例全麻手术患儿,随机均分为右美托咪定组(A组)和对照组(B组)。记录麻醉诱导前(T0)、拔管时(T1)、拔管后5min(T2)、拔管后15min(T3)时的MAP、HR、血浆肾上腺素(E)、去甲肾上腺素(NE)和皮质醇(Cor)的含量,记录手术时间、术后的苏醒时间。结果:两组患儿T1时MAP和T1、T2时HR、E、NE、Cor浓度与T0时比较均升高(P<0.05);T1时,B组的MAP(102±8)mmHg、HR(132±4)次/min、E(110±13)nmol/L、NE(202±31)nmol/L、Cor(812±91)μmol/L均高于A组MAP(89±7)mmHg、HR(116±6)次/min、E(69±11)nmol/L、NE(176±28)nmol/L、Cor(710±85)μmol/L,差异有统计学意义(P<0.05);两组患儿苏醒时间无明显差异。结论:右美托咪定能抑制小儿全麻后气管拔管期的应激反应,且不影响苏醒时间。

Objective： To observe the effects of dexmedetomidine on stress reaction during extubation period in children＇s general anesthesia. Methods： Sixty children undergoing general anesthesia were randomly divided into Dexmedetomidine group（group A） and control group （group B）. Levels of MAP, HR, serum epinephrine（E）, serum norepinephrine（NE） and serum cortisol（Cor） were respectively recorded before the induction of anesthesia（T0）, after during extubation（T1）, 5 min after extubation（T2） and 15 min after extubation（T3）. Meanwhile, the operation time and postoper ative recovery time were also recorded. Results： Compared with TO, levels of HR and serum concentrations of E, NE and Cor increased at T1 and T2 in both two groups, as well as MAP at T1 （P〈0.05）. At T1, the levels of MAP, HR, serum E, serum NE and serum Cor for group B were respectively （102±8）mmHg, （132±4）beats/min, （110±13）nmol/L, （202±31）nmol/L and （812± 91 ）μmol/L, which were significantly higher than those of group B （89 ±7） mmHg, （ 116 ±6） beats/rain, （69±11）nmol/L, （176±28）nmol/L and （710±85）μmol/L. However, no significant difference was found in the recovery time between the two groups. Conclusion： Dexmedetomidine can inhibit stress response in children with tracheal extubation after general anesthesia, but does not increase the postoperative recovery time.