右美托咪定对婴幼儿唇腭裂修复术麻醉复苏质量的影响

Effects of dexmedetomidine on repair of infants with cleftlip and palate anesthesia recovery quality

目的评价右美托咪定对婴幼儿唇腭裂修复术麻醉复苏质量的影响及安全性.方法：选择先天性唇腭裂修复术的婴幼儿60例.ASAⅠ级或Ⅱ级,随机分为两组（n=30）：右美托咪定组（A组）和对照组（B组）.手术开始前10 min,A组静脉泵注右美托咪定1ug/kg（稀释至20ml）,B组静脉泵注同等容量生理盐水（输注时间10 min）.两组患儿均采用气管插管静吸复合全身麻醉方法,术中维持A组采用右美托咪定-七氟烷复合麻醉;B组采用生理盐水-七氟烷复合麻醉.记录入室时（T0）、手术结束时（T1）、拔管前即刻（T2）、拔管后5 min（T3）,10 min（T4）,20 min（T5）时的MAP和HR.记录手术时间、拔管时间、躁动发生率、T4、T5时的疼痛行为评分及Ramsey镇静评分,记录术后需用舒芬太尼和丙泊酚的例数、呼吸抑制、恶心呕吐等不良反应的发生情况. 结果：两组拔管时间差异无统计学意义（P〉0.05）;与B组比较,A组在T2、T3、T4时的MAP降低,T2-T5时的HR减慢,在T4、T5时的疼痛评分降低,镇静评分升高,差异有统计学意义（P〈0.05）;A组术后需用舒芬太尼的例数减少;拔管后A组躁动发生率低于B组,差异有统计学意义（P〈0.05）;A组术后恶心呕吐和呼吸道事件明显低于B组,差异有统计学意义（P〈0.05）. 结论：右美托咪定能安全用于婴幼儿唇腭裂修复术麻醉,且可提高麻醉复苏质量.

ObjectiveTo evaluate the effect of dexmedetomidine on repair of infants with cleft lip and palate anesthesia recovery quality and safety. Methods：60 infants with congenital cleft lip and palate repair were selected. ASA class I or II, were randomly divided into two groups （n = 30）： Dexmedetomidine group （A group） and control group （B group）. At 10 min before surgery, group A intravenous infusion of dexmedetomidine 1ug / kg （20 ml）, group B intravenous infusion of an equal volume of saline （the infusion time is 10 minutes）. Two groups of children were treated with endotracheal intubation Intravenous Inhalation Combined with general anesthesia, was maintained in group A with dexmedetomidine and sevoflurane combined anesthesia; group B with physiological saline and sevoflurane combined anesthesia. Record MAP and HR on six point of time ,the operation time, pull tube time, agitation of the incidence, T4, T5 pain behavior score and Ramsey sedation score. Recorded postoperative need of sufentanil and propofol in the number of cases, respiratory inhibition, nausea, vomiting and other adverse reactions. Results：two groups of pulling tube time differences had no statistical significance （P〉0.05）. Compared with group B, group A at T2, T3, T4, MAP reduce, T2-T5 HR slowed down, at T4, T5, the pain score decreased, sedation scores were increased, the difference is statistically significant （P〈0.05）; The number of cases used sufentanil was reduced in group A; extubation after a group of restlessness was lower than that of group B, the difference is statistically significant （P〈0.05）;The postoperative nausea and vomiting and respiratory tract were significantly lower in A group than in B group, the difference was statistically significant （P〈0.05）.Conclusion：dexmedetomidine anesthesia can be safely used for repair of infants with cleft lip and palate, and can improve the quality of anesthesia recovery.