右美托咪定联合丙泊酚在小儿区域麻醉中镇静效果观察

The combination of dexmedetomidine and propofol for sedation in pediatric patients undergoing regional anesthesia

目的：观察和评价右美托咪定和丙泊酚联合用药在小儿区域麻醉手术中镇静效果。方法48例2～6岁区域麻醉下进行择期手术的患儿采用随机数字表法分为两组。右美托咪定丙泊酚联合用药组（DP组）静注丙泊酚1．0～2．5 mg／kg，并在10 min 内输注负荷量右美托咪定0．7μg／kg，之后丙泊酚以100～300μg·kg－1·min^－1持续输注，右美托咪定以0．5μg·kg^－1·h^－1输注。丙泊酚组（P组）静注1．0～2．5 mg／kg丙泊酚，之后以150～300μg·kg－1·min^－1持续泵入。所有患儿术中出现体动时追加丙泊酚1．0 mg／kg，给药后3 min内再次出现体动追加氯胺酮1．0 mg／kg。术中记录平均动脉压、心率、呼吸频率、血氧饱和度，记录丙泊酚的总使用量，记录患儿睁眼时间和出室时间，记录相关不良事件及术中辅助药物氯胺酮的需求量。结果DP组患儿术中丙泊酚用量为（149．00±24．93）μg·kg－1·min^－1，P组为（217．00±17．90）μg·kg^－1·min^－1， DP组丙泊酚使用量明显减少（t＝117．94，P＝0．00）。DP组和P组患儿术中氯胺酮追加次数分别为0.50（1.00）、2．00（1．00），DP组对辅助药物氯胺酮的需求量明显减少（Z＝－4．48，P＝0．00）。DP组患儿术中未出现低氧血症，P组出现5例，两组差异有统计学意义（χ^2＝5．58，P＝0．03）。DP组出室平均动脉压和心率分别为（74．96±5．69）mmHg、（101．17±9．65）次／min，同组基础值分别为（81．13±7．23）mmHg、（112．00±13.65）次／min，出室值与基础值比较差异有统计学意义（t＝10．78，P＝0．00；t＝10．08，P＝0．00）。两组患儿出室时间分别为（40．91±10．90）min、（39．67±14．95）min，差异无统计学意义（t＝0．11，P＝0．74）。结论联合使用右美托咪定和丙泊酚可以为小儿区域麻醉下进行的外科手术提供有效的镇静。

Objective To evaluate the effectiveness and safety of the combination of dexmedetomidine and propofol for sedation in pediatrics undergoing regional anesthesia.Methods Forty-eight children aged 2 -6 years old,scheduled for elective surgery under regional anesthesia,were randomly divided into the two groups.The dexme-detomidine plus propofol group（group DP,n=24）received an infusion over 10 minutes of dexmedetomidine 0.7μg/kg and propofol 1.0 to 2.5 mg/kg bolus for induction,then an infusion of dexmedetomidine 0.5μg·kg-1·h-1 and propofol 100-300μg·kg-1·min-1 for maintenance.The propofol group（group P,n=24）received a propofol 1.0 to 2.5mg/kg bolus for induction,then an infusion of propofol 150 -300μg·kg-1 ·min-1 for maintenance.If body movement was detected during surgery,a bolus of propofol 1 .0mg/kg was administered in both groups,and if there was another body movement within three minutes of the propofol bolus,a bolus of ketamine 1 .0mg/kg was adminis-tered.Hemodynamic data,respiratory rate,and oxygen saturation were recorded by researchers blinded to the study drugs.Recovery time and the primary outcome were evaluated by a modified Aldrete score.The occurrence of adverse events and the amount of supplemental ketamine used were also recorded.Results The consumption of propofol in the group DP was （149.00 ±24.93）μg·kg-1·min-1,and in the group P was （217.00 ±17.90）μg·kg-1· min-1.The propofol consumption was significant lower that in group DP（t=117.94,P=0.00）.The needs for sup-plemental ketamine bolus in the group DP was 0.50（1.00）/case,and it was 2.00（1.00）/case in group P.The need for supplemental ketamine was less in group DP（Z=-4.48,P=0.00）.Hypopnea occurred in 5 cases in group P, and 0 in group DP.The incidence of hypopnea was more in group P（χ^2 =5.58,P=0.03）.In group DP,the mean arterial pressure and heart rate at discharge were respectively （74.96 ±5.69）mmHg and （101.17 ±9.65）bpm,and their baseline values were （81.13 ±7.23）mmHg and （112.00 ±13.65）bpm.Both mean arterial pressure and heart rate in the group DP remained decreased at discharge（t=10.78,P=0.00;t=10.08,P=0.00;respectively）.The discharge time of the group DP was （40.91 ±10.90）min and it was（39.67 ±14.95）min in group P.There was no significant difference in the discharge time（t=0.11,P=0.74）.Conclusion The combination of dexmedetomidine and propofol can provide appropriate depth of sedation in pediatric patients undergoing regional anesthesia.