右美托咪定预防小儿全麻术后苏醒期躁动的临床研究

Study of Dexmedetomidine on Agitation during Recovery from General Anesthesia in Children

目的:探讨右美托咪定对小儿全麻术后苏醒期躁动的控制效果。方法:选择2010年10月至2014年7月我院耳鼻喉科择期手术患儿188例,随机分为右美托咪定组(D组)68例、芬太尼组(C1组)68例和生理盐水组(C2组)52例。三组患儿均在术前1周停用镇静类药物,术前常规准备。术毕前10 min开始,D组给予右美托咪定负荷量0.5μg/kg静脉注射(注射时间>10min),C1组给予芬太尼1μg/kg静脉注射,C2组给予生理盐水5 m L静脉注射,镇静期间患儿若出现体动或躁动则给予追加异丙酚2 mg/kg辅助镇静。观察和记录三组患儿镇静期间的生命体征、追加异丙酚次数、Riker镇静躁动评分、人工辅助通气次数、拔管时间、出室时间等。结果:三组患儿术后呼吸循环变化均无明显异常,心率(HR)、血压(BP)比较差异无统计学意义(P>0.05)。三组患儿Riker镇静躁动评分比较,D组<C1组<C2组(P<0.01);追加异丙酚次数,D组<C1组<C2组(P<0.01);拔管与出室时间,C2组<D组<C1组(P<0.05)。三组患儿苏醒期均未行辅助通气,拔管后均未出现通气受限、呕吐、误吸等并发症,C1组有5例出现短暂的窦性心动过缓。结论:右美托咪定在预防小儿全麻后苏醒期躁动方面有明显镇静效果,且不良反应少。

Objective： To investigate the effect of dexmedetomidine on agitation during recovery from general anesthesia in children. Methods： From October 2010 to July 2014, our hospital otolaryngology undergoing elective surgery in children with 188 cases, were randomly divided into the dexmedetomidine group （group D） 68 cases, fentanyl group （C1） 68 cases and normal saline group （C2）52 cases. Three groups of children stoped using sedative drugs 1 week before operation, all children were given routine preoperative preparation. Ten rain before operation to complete, group D was given the dexmedetomidine 0.5 Ixg/kg intravenous injection （ 〉 10 min）, group C1 was given fentanyl 1 ~g/kg, group C2 was given saline 5 mL, propofol 2 mg/kg were given additionally auxiliary calm when children appear body move or agitation. Observed and recorded the vital signs, the additional number of propofol, Riker calm restless score, assisted ventilation times, time of extubation and out of the room, etc. of three groups during calming. Results： Three groups of postoperative respiratory cycle changed have no obvious abnormalities, there were no statistical significances of heart rate （ HR）, blood pressure （BP） （ P〉0.05 ）. Three groups of children with Riker calm restless score comparison, group D〈group C1 〈group C2 （P〈0.01）, additional number of propofol, group D〈group C1 〈group C2 （P〈0.01）, time of extubation and out of the room, group C2〈group D〈group C I （P〈0.05）. Three groups of children with awakening period hael not been assisted ventilation, no limited ventilation, vomiting occurred after extubation, group C1 had 5 cases with short sinus bradycardia. Conclusion： Dexmedetomidinc can reduce the occurrence of agitation during recovery from general anesthesia in children.