右美托咪定复合七氟烷麻醉在小儿烧伤短小手术中的应用效果观察

Application effects of dexmedetomidine combined with sevoflurane for anesthesia in short operations in children with burn injury

目的观察右美托咪定复合七氟烷用于小儿烧伤短小手术的有效性及安全性。方法将40例拟行烧伤短小手术（〈30min）的住院患儿随机分为七氟烷组（S组）和七氟烷复合右美托咪定组（D组）,每组20例。D组经面罩吸入8%七氟烷,待患儿睫毛反射消失后建立静脉通路,改用3%七氟烷面罩吸入维持,同时开始以5μg/（kg.h）速度泵注右美托咪定10min,然后减为0.5μg/（kg.h）,然后开始手术直至手术结束。S组仅吸入七氟烷,使用同等容量生理盐水代替右美托咪定。术中根据患儿的体动情况,需要时静注丙泊酚3mg/kg。监测患儿入室（T_1）、睫毛反射消失（T_2）、泵注右美托咪定10min（T_3）、手术5min（T_4）、手术10min（T_5）、手术结束（T_6）时的心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（Sp O_2）及Ramsay镇静评分,记录手术完成时间、麻醉时间、丙泊酚用量、呼吸抑制情况、麻醉后恢复室（PACU）内小儿苏醒期躁动（PAED）评分。结果手术时间在两组间比较差异无统计学意义;术中Sp O_2 D组高于S组,D组有4例、S组10例出现呼吸抑制（P〈0.05）;丙泊酚用量D组少于S组,但手术时间D组长于S组（P〈0.05）;T_3~T_6时点D组MAP、HR低于S组（P〈0.05）,Ramsay镇静评分高于S组（P〈0.05）;在PACU内,D组PAED评分低于S组（P〈0.05）。结论右美托咪定复合七氟烷用于烧伤患儿短小手术的麻醉,患儿循环指标稳定,对呼吸影响小;虽然苏醒时间有所延长,但可提高苏醒质量。

Objective To evaluate the effectiveness and safety of dexmedetomidine combined w ith sevoflurane for anesthesia in short operations in pediatric burn patients. Methods Forty hospitalized children undergoing short operation for burn injury were allocated to sevoflurane group（S group） or sevoflurane combined dexmedetomidine group（group D）（20 patients each）. Children in group D inhaled 8% sevoflurane in the beginning until loss of eyelash reflex, and then the density of sevoflurane was reduced to 3% for maintenance, 5μg/（kg.h） of dexmedetomidine was pumped for 10 mins, then the density was reduced to 0.5μg/（kg.h）. Then operation was started herewith till to the end. Children in group S received sevoflurane anethesia alone, and dexmedetomidine was replaced by the same volume of physiological saline. Additional 3mg/kg propofol was injected when anesthesia was inadequate. During the procedure, HR, MAP, Sp O_2 and Ramsay scale were recorded at baseline（T_1）, loss of eyelash reflex（T_2）, 5min after the start of operation（T_4）, 10min（T_5） and the end of operation（T_6）. The operation time, anethesia time, propofol consumption, case of respiratory depression and pediatric anesthesia emergence delirium scale（PAED） in pediatric anesthesia care unit（PACU） were recorded. Results There was no significant difference in operation time between the two groups. Intraoperative Sp O_2 was higher in group D than in group S（P〈0.05）, respiratory inhibition occurred in 4 cases of group D and 10 cases of group S（P〈0.05）. Propofol consumption was less and the operation time was longer in group D than in group S（P〈0.05）. At T_3-T_6, the MAP and HR were lower, but the Ramsay scale was higher in group D than in group S（P〈0.05）. In PACU, PAED scale was lower in group D than in group S（P〈0.05）. Conclusions Dexmedetomidine combined with sevoflurane for anesthesia for short burn surgery in children not only stabilize hemodynamic parameters but also reduce the impact to respiration. Although delaying the recovery time, this combination may improve the recovery quality.