术中微泵静脉注射右美托咪定对七氟烷全身麻醉小儿苏醒期躁动的影响

Effect of Dexmedetomidine on Emergence Agitation in Children During Sevoflurane Anesthesia

目的评价微泵静脉注射Dex 0.2μg/(kg·h)对七氟烷吸入全身麻醉下腹腔镜腹股沟斜疝手术小儿苏醒期躁动(EA)的影响。方法研究采用双盲、随机、对照方法。美国麻醉医师学会(ASA)Ⅰ级、择期全身麻醉下行腹腔镜腹股沟斜疝手术小儿60名,采用数字表法随机分为Dex组(D组)及生理盐水对照组(C组),每组30例。D组患儿气管插管后微泵静脉注射浓度为2μg/ml Dex 0.2μg/(kg·h),C组患儿微泵静脉注射生理盐水0.1ml/(kg·h)。术中吸入1%~2%七氟烷维持麻醉,保持BIS评分在40~60之间。缝合皮肤时,停用七氟烷及Dex,送至麻醉苏醒室(PACU)。以Wong-Baker疼痛脸谱评估患儿疼痛程度,以小儿苏醒期躁动量表(PAED)评估患儿EA程度,PAED≥10分表示EA。记录、比较两组患儿入室时(T0)、麻醉诱导完成后(T1)、手术开始5min(T2)、10min(T3)、术毕(T4)的平均动脉压(MAP)、心率(HR);患儿苏醒时间,拔管时间、PACU留置时间;苏醒期明显疼痛(Wong-Baker疼痛评分≥6)患儿人数、比例及曲马多用量;EA发生人(次)数、比例及丙泊酚用量;PACU期间患儿呼吸抑制、恶心、呕吐等不良反应发生情况。结果 T2、T3、T4时间点D组患儿HR明显慢于T0(P<0.05),也明显慢于C组患儿(P<0.05);C组、D组患儿T1时间点MAP均明显低于T0(P<0.05);D组患儿苏醒时间、拔管时间分别为8.9±2.1min、10.5±2.1min,明显长于C组(P<0.05),但PACU留置时间与C组相似(P>0.05);D组、C组患儿EA发生率分别为10%(3例)、53.3%(16例),C组EA发生率明显高于D组(P<0.05);明显疼痛人数两组发生率相似(P>0.05),两组各有1例(3.3%)患儿发生呼吸抑制不良反应,但均为一过性,通过吸氧、托下颌等措施及时纠正。两组患儿PACU期间未发生恶心呕吐。结论气管插管后以0.2μg/(kg·h)静脉注射Dex能有效降低七氟烷吸入全身麻醉腹腔镜下腹股沟斜疝手术小儿EA的发生率。

Objective To evaluate the effectiveness of dexmedetomidine（Dex） infusion on emergence agitation in children undergo- ing laparoscopic inguinal hernia operations during sevo？ urane anesthesia. Methods Sixty ASA I children were enrolled in a double - blinded randomized pilot study to receive dexmedetomidine （group D） or normal saline （group C） for sedation during laparoscopic ingui- nal hernia operations. After general anesthesia induction,children in group D were intravenous infused with 0.2txg/（ kg ~ h） Dex or the same volumes of normal saline in group C. Sevoflurane was used for maintenance of anesthesia,and to achieve a BIS score of 40 - 60 dur- ing surgery. When skin suture was started, sevoflurane and DEX or saline administrations were discontinued. Mean arterial pressure （MAP） and heart rate（HR） at the time of before anesthesia（ TO ） , completion of induction of general anesthesia （ T1 ） , 5 min after opera- tion （T~）, 10 min after operation （T~） and operation finished （T4 ） were recorded. The recovery time, extubation time, postoperative pain score （Wong- Baker） , paediatric agitation and emergence delirium （PAED） score,the incidence of emergence agitation and PACU indwelling time were documented. The side effects such as respiratory depression and nausea and vomiting were also recorded. Results The HR in group D at the time of T2 ,T3 ,T4were lower than that at the time of To （ P 〈 0.05 ）, and also lower than that in group C, respec- tively. The MAP in group D and grouop C at the time of T^were lower than that at the time of To （ P 〈 0.05 ）. The recovery and extubation time in group D were longer than that in group C （ P 〈 0.05 ） , while the PACU indwelling time were similar between two groups （ P 〉 0. 05）. The incidence of emergence agitation was lower in group D than in group C （ 10% vs. 53.3% , P 〈 0.05）. The side effects had no significant differences between two groups. Conclusion Intravenous infusion of 0.21xg/（ kg· h） Dex after tracheal intubation can ef-fectively reduce the incidence of emergence agitation in children undergoing laparoscopic inguinal hernia operations during sevoflurane an- esthesia.