右美托咪定预防小儿扁桃体切除术后苏醒期躁动及其血流动力学反应的临床研究

Clinical research of Dexmedetomidine for prevention of emergence agitation and hemodynamic responses in pediatric patients undergoing tonsillectomy

目的探讨右美托咪定对小儿扁桃体切除术后苏醒期躁动的预防效果及其对血流动力学的影响。方法收集2013年8月-2015年4月也门荷台达革命医院择期行扁桃体切除术的患儿50例,随机将其分为右美托咪定组（D组）和对照组（C组）,每组25例。麻醉诱导插管后,D组静注右美托咪定0.5μg/kg,注射时间10 min。C组输注相同容量的0.9%氯化钠注射液,其余麻醉方法相同。观察两组的拔管时间、出室时间、苏醒期Riker镇静躁动评分,比较两组患儿麻醉前（T0）、拔管前（T1）、拔管后（T2）的收缩压（SBP）、舒张压（DBP）、心率（HR）,计算各观察时点的二重指数（RPP）。结果两组患儿拔管时间、出室时间差异无统计学意义（P〉0.05）;D组患儿Riker镇静躁动评分优于C组,差异有统计学意义（P〈0.05）;与T0比较,D组T1、T2时SBP、DBP、HR、RPP略有增加,差异无统计学意义（P〉0.05）;C组T1、T2时SBP、DBP、HR和RPP升高,差异有统计学意义（P〈0.05）;T1、T2时C组SBP、DBP、HR、RPP高于D组,差异有统计学意义（P〈0.05）。结论右美托咪定对扁桃体切除术后小儿苏醒期躁动有明显的预防效果,患儿血流动力学更稳定。

Objective To investigate the effect of Dexmedetomidine on emergence agitation and hemodynamic responses in pediatric patients. Methods From August 2013 to April 2015,Yemen Hudaydah Revolution Hospital,50 pediatric patients undergoing elective tonsillectomy,were randomly allocated to dexmedetomi dine group（group D,n=25） and control group（group C,n=25）.After anesthetic induction,group D was given the Dexmedetomidine 0.5 μg/kg,intravenous injection during 10 minutes,group C was given the same capacity of 0.9% normal saline intravenous injection during 10 minutes.Parameters records including time of tracheal extubation and out of operating theatre;riker calmrestless score;noninvasive heart rate（HR）,systolic blood pressure（SBP） and diastolic blood pressure（DBP） before anesthetic induction（T0） and before（T1） and after tracheal extubation（T2）;rate-pressure product（RPP） were calculated. Results There was no difference in time of tracheal extubation and out of operating theatre（P〉0.05）;riker calmrestless score in group D was significantly better than group C,there was significant difference（P〈0.05）;the SBP,DBP,HR and RPP compared preinduction（T0） with before（T1） and after（T2） tracheal extubation in group D, there were no significant differences（P〉0.05）;the SBP,DBP,HR and RPP compared preinduction（T0） with before（T1） and after（T2） tracheal extubation in group C,there were significant differences（P〈0.05）.In group D,SBP,DBP,HR and RPP at T1 and T2were significant lower than those in group C with significant differences（P〈0.05）. Conclusion Dexmedetomidine can reduce the occurrence of emrgence agitation and hemodynamic responses in pediatric patients undergoing tonsillectomy.