地佐辛单独或复合盐酸右美托咪定在小儿手术中的临床应用效果比较

Clinical efficiency of single application of dezocine or combined with dexmedetomidine hydrochloride during general anesthesia surgery in children

目的探讨地佐辛单独或复合盐酸右美托咪定（DEX）在小儿手术中的应用效果。方法选取全麻下手术患儿129例,随机分为联合、单药、对照3组,每组43例,联合组在麻醉诱导插管前泵注DEX并维持至手术毕,单药、对照组同期泵注0.9%氯化钠溶液,于术毕前15 min予单药组、联合组泵注地佐辛,对照组给予0.9%氯化钠溶液,设定术前（T1）、泵注后5 min（T2）、插管即刻（T3）、拔管即刻（T4）、拔管后5 min（T5）、术后1 h（T6）、术后2 h（T7）、术后4 h（T8）、术后6 h（T9）、术后24 h（T10）10时间点,观察3组相应时间点生命体征、手术及镇静镇痛情况,血清P物质（SP）、β-内啡肽（β-EP）、孤啡肽（OFQ）浓度以及术后72 h内不良反应发生情况。结果联合组T3-T7的时间点HR、MAP、七氟醚用量上远少于另外2组但拔管时间却更长（P〈0.05）;联合组术后躁动评分、躁动发生率数上均少于另外2组且在T6-T8的VAS评分及T6-T10的FLACC评分又明显低于对照组,同时在T6-T8的FLACC评分又远低于单药组,差异有统计学意义（P〈0.05）;联合组T6时镇静评分显著高于单药组、对照组而术后个时间段其SP、β-EP及OFQ的血清浓度又低于另外2组（P〈0.05）;术后联合组不良反应发生率明显低于另外2组（P〈0.05）。结论地佐辛复合DEX应用于小儿全麻手术,安全有效,值得临床推广。

Objective To observe the clinical efficiency of single application of dezocine or combined with dexmedetomidine hydrochloride（ DEX） during general anesthesia surgery in children. Methods One hundred and twentynine children patients who were scheduled for ophthalmologic operation under general anesthesia were randomly divided into 3groups： combination medication group,single medication group and control group,with 43 patients in each group. Before anesthesia induction,the patients in combination medication group were given DEX by intravenous infusion,keeping it to the end of operation,however,the patients in single medication group and control group were given 0. 9% sodium chloride solution by pump infusion,at 15 min before end of operation,the patients in single medication group and combination medication group were given dezocine by pump infusion,but the patients in control group were given still 0. 9% sodium chloride solution. The10 time points were set up,which were before operation（ T1）,5min after pumping（ T2）,intubation instantly（ T3）,extubation instantly（ T4）,5min after extubation（ T5）,1h after operation（ T6）,2h after operation（ T7）,4h after operation（ T8）,6h after operation（ T9）,24 h after operation（ T10）. The intraoperative and postoperative vital signs of patients,operation and analgesia status,serum levels of substance P（ SP）,concentrations of β-endorphin（ β-EP）,orphanin FQ（ OFQ） in the 10 time points and adverse reactions after 72 hours were observed and compared among the three groups.Results The levels of MAP,HR and dosage of sevoflurane in T3,T7 in combination medication group were significantly lower than those in the other two groups,however,the extubation time was significantly longer than that in the other two groups（ P〈0. 05）. The restlessness scores and incidence rate of restlessness in combination medication group were significantly lower than those in the other two groups,moreover,the VAS scores in T6,T8 and FLACC scores in T6,T10 were significantly lower than those in control group,besides the FLACC scores in T6,T8 were significantly lower than those in single medication group（ P〈0. 05）. The sedation scores in T6 in combination medication group were significantly lower than those in the other two groups,moreover,the serum levels of SP,β-EP and OFQ after operation were also significantly lower than those in the other two groups（ P〈0. 05）. Conclusion The dezocine combined with DEX is safe and effective in application during general anesthesia surgery in children,thus,which is worth using widely in clinical practice.