右美托咪定预防小儿扁桃体摘除术苏醒期躁动

Dexmedetomidine prevent agitation in children tonsil extirpate awakening period

目的旨在证实手术期间给予右美托咪定能减少芬太尼、七氟烷全麻下行扁桃体摘除术患儿苏醒期谵妄的发生率。方法选择本院2013年12月~2015年6月60例（5~11岁）行扁桃体摘除术患儿,随机分成两组。一组快速泵注右美托咪定负荷量1μg/kg,10 min泵完（FD组,n=30）,接着持续输注0.2μg/（kg·h）;另一组同样方式泵注生理盐水（FS组,n=30）。2%~3%七氟烷维持全麻。心率或收缩压超过基础30%追加芬太尼1μg/kg。记录不同时间点的平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（Sp O2）以及手术时间、拔管时间。恢复室内记录客观疼痛评分（objective pain score,OPS）、苏醒期躁动（emergence agitation,EA）评分、儿童苏醒期躁动谵妄（paediatric agitation and emergence delirium,PAED）评分。记录躁动的发生率、术后给予芬太尼镇痛的次数。结果两组患儿在手术时间、拔管时间方面差异无显著性;FD组追加芬太尼次数以及T1~T6时刻HR、MAP显著低于FS组;FD组平均最大EA、OPS、PAED值显著低于FS组（P〈0.05）;FS组躁动的发生率（17例,56.7%）大于FD组（5例,16.7%）。结论右美托咪定可以减轻七氟烷全麻行扁桃体摘除的患儿术后躁动的发生率,较好地稳定血流动力学,减少镇痛药使用量且不延长拔管时间。

Objective To test whether the infusion of dexmedetomidine to fentanyl treatment reduced the incidence of emergence delirium（ED）following sevoflurane anesthesia in children undergoing tonsillectomy surgery. Methods A total of 60 children（5 to 11 years old） undergoing tonsillectomy surgery in our hospital from December 2013 to June 2015 were divided into two groups. Patients were infused with 1 μg/kg dexmedetomidine within 10 minutes then maintained with 0.2 μg/（kg·h） dexmedetomidine（Group FD, n=30）. Patients in Group FS（n=30） were infused with normal saline as the same way. Anaesthesia was maintained with 2% to 3% sevoflurane. Fentany（1 μg/kg） was given to whose MAP or HR above the baseline 30%. The changes of MBP, HR, SPO2 were recorded at different time points as well as the time of operation and extubation. Objective pain score（OPS）, Paediatric Agitation, Emergence Delirium（PAED） score, EA score and the frequency of fentanyl rescue were documented in the post-anaesthesia care unit. Results There were no significant differences between the two groups at the time of operation and extubation the MAP, HR at T1 to T6of FD was lower than FS. The mean values of maximum EA, maximum PAED, and maximum OPS score were significantly lower in Group FD than in Group FS. The frequency of fentanyl rescue was lower in Group FD than that in Group FS（P〈0.05）. The incidence of severe EA was significantly lower in Group FD（5 cases） than that in Group FS（17 cases）（16.7% vs 56.7%）. Conclusion Infusion of dexmedetomidine in addition to fentanyl reduces EA following sevoflurane anaesthesia in children undergoing tonsillectomy surgery.