右美托咪定联合七氟醚及骶管阻滞麻醉在小儿下腹部手术中的应用

Dexmedetomidine combined with sevoflurane and sacral anesthesia applied in children undergoing ambulatory surgery

目的 探讨右美托咪定联合七氟醚及骶管阻滞麻醉在小儿下腹部手术中应用的可行性.方法 选择择期行下腹部手术患儿40 例,随机分为两组（n=20）.两组均采用保留自主呼吸面罩紧闭吸入七氟醚联合骶管阻滞麻醉,吸入麻醉诱导成功后,行骶管阻滞并建立静脉通道,右美托咪定组（D 组）给予1 μg/kg 右美托咪定（右美托咪定用生理盐水稀释至1 μg/ml）10 min 静脉泵入,随后予0.1 μg·kg^-1·h^-1 静脉泵入直至手术结束;对照组（C 组）给予1 ml/kg 生理盐水10 min静脉泵入,随后予0.1 ml·kg^-1·h^-1 生理盐水静脉泵入至手术结束.观察记录右美托咪定用药前（T0）、用药后10 min（T1）、切皮前（T2）、切皮后1 min（T3）、手术结束时（T4）和麻醉苏醒时（T5）各时点患儿的平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）.记录手术时间、麻醉苏醒时间、患儿苏醒后躁动评分及术后30 min 疼痛评分.记录恶心、呕吐、呼吸抑制、尿潴留等不良反应发生情况.结果 与C 组比较,D 组HR 及MAP 在T1～T5 时均降低（P〈0.05）.与T0 时比较,D 组HR 及MAP 在T1～T5 时均降低（P〈0.05）.D 组苏醒期躁动评分和疼痛评分均明显低于C 组（P〈0.05）,两组苏醒时间无统计学差异（P〉0.05）.结论 右美托咪定联合七氟醚及骶管阻滞麻醉可安全用于小儿下腹部手术,且降低患儿躁动并减轻疼痛的发生。

Objective To study the effect of dexmedetomidine combined with sevoflurane and sacral anesthesia applied in children undergoing ambulatory surgery. Methods Forty children aged 2 to 8 years, undergoing ambulatory surgery, were randomly divided into two groups (n=20 each). All the children were given sevoflurane and sacral anesthesia. The children in group D(dexmedetomidine group) were given 1 μg/kg of dexmedetomidine (1 μg/ml diluted by normal saline), which were infused intravenously in 10 min after establishing vein channels, and then infused intravenously at the rate of 0.1μg·kg-1·h-1 until the end of surgery, group C (control group) received the same volume of normal saline at the same time and at the same rate. Mean arterial pressure (MAP) and heart rate (HR) and oxyhemoglobin saturation (SpO2) were recorded before the drug infusion (T0), at 10 min after drug infusion (T1), before skin incision (T2), at 1 min after skin incision (T3), at the end of surgery (T4) and the time of wake up (T5). The time of surgery and the time of wake up, agitation score and pain score and side effects were also recored respectively. Results Compared with group C, the MAP and HR were decreased from T1 to T5 significantly (P<0.05). The MAP and HR were lower at T1 to T5 in group D than those at T0 (P<0.05). The agitation score and pain score were lower in group D than in group C (P<0.05). However, the time of wake up was not different between the two groups. Conclusion Intraoperative infusion of dexmedetomidine combined with sevoflurane and sacral anesthesia can be applied safely in children undergoing ambulatory&nbsp;surgery with decreasing agitation and postoperative pain score.