麻醉诱导前应用右美托咪定对小儿术后瑞芬太尼镇痛镇静的影响

Influence of dexmedetomidine injected before induction of anesthesia on pediatric postoperative analgesia and sedate effects with remifentanil

目的观察在小儿静脉与吸入复合麻醉诱导前应用右美托咪定1Fg／kg对小儿术后瑞芬太尼镇痛效果的影响及安全性。方法肠切除患儿60例。将其随机分为瑞芬太尼组（R组，n=30）和右美托咪定联合瑞芬太尼组（DR组，n=30）。DR组麻醉诱导前静脉泵注右美托咪定1gg／kg，R组泵注同等容量的生理盐水。缝皮时采用自控镇痛，两组均为瑞芬太尼24gg／kg，格拉司琼0．1mg／kg，用生理盐水稀释至100ml。分别于术毕、术后不同时间采用FACES脸谱评分和Ramsay评分评价术后镇痛及镇静情况，并记录两组患儿不良反应及家长满意度。结果DR组FACES、Ramsay评分明显优于R组（P〈0．05）；两组均未见呼吸抑制；R组有5例发生呕吐，明显多于DR组的1例（P〈0．05）；DR组家长满意度明显高于R组（P〈0．05）。结论右美托咪定1gg／kg麻醉诱导前应用有助于提高麻醉苏醒期瑞芬太尼的镇痛镇静效果，比单纯应用瑞芬太尼更舒适，家长满意度更高。

Objective To observe the influence and safety of dexmedetomidine 1μg/kg given before the induction of anesthesia on the analgesic and sedate effects of rcmifentanil in pediatric postoperative analgesia. Methods Sixty children scheduled for bowel resection surgery were randomly divided into 2 groups： dexmedetomidine combined with remifentanil group （group DR, n=30） and remifentanil group （group R, n=30）. Dexmedetomidine 1 μg/kg was given before the induction of anesthesia in group DR, normal saline in group R. Analgesic mixture including remifentanil 24μg/kg, granisetron 0.1 mg/kg, diluted to 100 ml, was given to both groups. The postoperative analgesia and sedation was assessed with FACES Face Ratings and Ramsay score at the end of operation, and at 2,6,12 and 48 h after surgery. Times of pressed the analgesic pump, the incidence of side effects and parent＇ s satisfaction scores were recorded. Results FACES and Ramsay scores in group DR were signifieantly better than those in group R （P〈 0.05）. There was no occurrence of respiratory depression in both groups. Parent＇s postoperative satisfaction score in group DR was higher than that in group R （P 〈 0.05 ）. There were 5 patients vomiting in group R, but only l in group DR （ P 〈 0.05 ）. Conclusion With appli- cation of dexmedetomidine 1μg/kg given before the induction of anesthesia, the analgesic and sedation effects of remifentanil can be improved, with high comfort level and patient＇ s satisfaction, which is better than application of remifentanil only.