右美托咪定在儿童局麻包皮手术中的临床应用

Clinical Application of Dexmedetomidine in Local Anaesthesia of Pediatric Circumcision

目的：观察右美托咪定用于儿童局麻包皮手术的临床效果。方法：选择美国麻醉医师协会（ASA）分级Ⅰ~Ⅱ、体质量26~42 kg、择期行包皮环切术的儿童60例,随机分成两组,每组30例。其中A组为咪达唑仑组,局麻前以0.1 mg/kg咪达唑仑静脉注射;B组为右美托咪定组,在局麻前给予1μg/kg右美托咪定负荷剂量,10 min内泵注完,术中0.5μg/（kg·h）静脉持续泵注维持。记录儿童入室时（T1）、局麻时（T2）、手术开始时（T3）、5 min（T4）、10 min（T5）以及手术结束时（T6）的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）和脉氧饱和度（SpO2）。术中在各时间点对儿童行VAS疼痛评分以及Ramsay镇静评分,并记录手术持续时间和局麻药使用量。结果：两组儿童T1的MAP、HR、SpO2、RR差异无统计学意义（P〉0.05）,B组在T2~T6时间点的MAP和HR明显低于A组,且B组MAP和HR的变化趋势较A组缓和（P〈0.05）。B组在T2~T6时间点的VAS疼痛评分和Ramsay镇静评分显著低于A组（P〈0.05）,两组儿童的手术持续时间以及局麻药物使用量差异无统计学意义（P〉0.05）。结论：右美托咪定辅助局麻行儿童包皮手术,产生了满意的镇静和镇痛作用,有效地维持儿童术中的循环稳定,提高了手术的安全性。

OBJECTIVE： To observe the clinical efficacy of dexmedetomidine in local anaesthesia of pediatric circumcision. METHODS： 60 pediatric patients （ASA Ⅰ -Ⅱ, 26-42 kg） underwent circumcision were randomly divided into 2 groups （n= 30）. Before local anaesthesia, group B as dexmedetomidine group received the loading dose of demedetomidine 1 μg/kg and pumped within 10 min, and the continuous infusion was 0.5 μg/（kg.h） during the operation; group A as midazolam group was given intra- venous injection of midazolam 0.1 mg/kg after local anaesthesia. The changes of MAP, HR, RR and SpO2 were recorded at the time of inter-room（Tx）, the time of local anaesthesia （T2）, at the beginning of the operation （T3）, 5 min after operation （T4）, 10 min after operation （T5） and at the end of operation （T6）. VAS and Ramsay sedation scale of all patients were collected at each time point. The operation duration and local anaesthesia consumption were recorded at the end of operation. RESULTS： At T1, MAP, HR, SpO2 and RR of 2 groups showed no statistical significance （P〉0.05） ; At T2-T6, MAP and HR of group B were significantly lower than those of group A （P〈0.05）. MAP and HR of group B were more stable than those of group （P〈0.05）. At T2-T6, VAS and Ramsay sedation scale of group B were significantly lower than those of group A （P〈0.05） ; operation duration and local anaesthesia consumption had no statistical significance （P〉0.05）. CONCLUSIONS： In the circumcision of pediatric patients, local anaesthesia of dexmedetomidine shows good sedative and analgesic effect. It can effectively sustain the stability of pediatric cardiovascular system during operation and improve the safety of the circumcision.