右美托咪定在儿科骶麻行尿道下裂矫形术的临床应用

Clinical application of dexmedetomidine in the sacral canal anesthesia of children undergoing hypospadias orthopedics

目的 探讨右美托咪定在儿科骶麻行尿道下裂矫形术的临床应用。方法 选取行择期尿道下裂矫形术的患儿45例,所有患者随机分为右美托咪定组（n=23）和对照组（n=22）。右美托咪定组在骶麻成功后前10 min给予负荷剂量1μg/kg的右美托咪定泵入,之后0.5μg/（kg·h）维持。而对照组在骶麻成功后前10 min给予1 mg/kg的丙泊酚泵入,之后给予2~4mg/（kg·h）维持。记录T0（入室后）、T1（勾阴茎头）、T2（切皮）和T3（切尿道板）4个时间点的心率（HR）、血氧饱和度（Sp O2）、平均动脉压（MAP）和脑电双频谱指数（BIS）值,并抽取这4个时间点外周血至本院检验科检测血糖、皮质醇和肾上腺素水平,同时记录术后苏醒时间和术后发生躁动的情况。结果 与对照组相比,右美托咪定能够降低T2和T3两个时间点的HR和MAP（P〈0.05）,同时降低T1、T2和T3三个时间点因应激而增高的皮质醇和肾上腺素水平（P〈0.05,P〈0.01）。右美托咪定用药组未发生术后躁动。结论 儿科骶管麻醉行尿道下裂矫形术中使用右美托咪定辅助镇静可以减轻手术的应激反应,减少术后躁动,且无明显呼吸抑制作用。

Objective To investigate the clinical application of dexmedetomidine in sacral canal anesthesia of children undergoing hypospadias orthopedics. Methods A total of 45 children were randomly assigned to two groups： dexmedetomidine group （n=23） ：1μg/kg dexmedetomidine in 10 minutes, followed by 0.5μg/（kg.h） until 5 minutes before the end of the surgery; Control group （n=22） ： 1 mg/kg propofol in 10 minutes, followed by 2-4 mg/（kg.h） as maintenance of anesthesia. Pulse oximetry （SpO2）, heart rate （HR）, BIS and arterial pressure （MAP） at TO （baseline）, T1 （pull the penis head）, T2 （cut the skin）, T3 （cut the urethral plate） were recorded. Blood glucose, adrenaline and cortisol concentration were measured. The time of anesthesia awake, postoperative agitation, and other adverse reactions were recorded. Results Compared with the control group, the dexmedetomidine treatment reduced HR and MAP at T2 and T3 （P〈0.05）, as well as levels of cortisol and adrenaline at T1, T2 and T3 （P 〈 0.05, P 〈 0.01）. In addition, there was no children with postoperative agitation in dexmedetomidine group. Conclusion Dexmedetomidine administration for sedation in children undergoing hypospadias orthopedics with sacral canal anesthesia can reduce stress action and postoperative agitation, and has little impact on breathing.