右美托咪定对小儿七氟烷全麻术后躁动的预防作用

Preventive Effects of Dexmedetomidine on Postoperative Agitation of Pediatric Sevoflurane General Anesthesia

目的：探讨右美托嘧啶对小儿七氟烷全麻术后躁动的预防作用。方法：选取在全麻下行扁桃体/腺样体切除手术的患儿41例,按随机数字表法分为SD组（21例）和SN组（20例）。两组患儿均以阿托品0.01 mg/kg、顺式阿曲库铵0.15 mg/kg、8%七氟烷进行麻醉诱导。插管成功后,待双肺听诊呼吸音清晰对等后进行机械通气,并静脉泵注瑞芬太尼0.15μg/（kg·min）。手术开始后静脉泵注右美托咪定0.5μg/（kg·h）（SD组）或生理盐水0.5μg/（kg·h）（SN组）。手术结束时停用麻醉药物,待观察到患儿自主呼吸良好、潮气量恢复正常、吞咽反射及咳嗽反射恢复时予以拔管。记录两组患儿静脉泵注右美托咪定前（T1）和静脉泵注后10 min（T2）、20 min（T3）、30 min（T4）,以及拔管时（T5）的心率（HR）和平均动脉压（MAP）;观察两组患儿的术后拔管时间、睁眼时间和不良反应发生情况;对两组患儿的术后躁动程度和疼痛程度（CHIPPS评分）进行评分。结果：SD组患儿给药后各时点的MAP和HR均较给药前下降,但SN组患儿未见类似变化,T2-T5时点组间MAP和HR比较,差异均有统计学意义（P〈0.05）。SD组患儿术后拔管时间和睁眼时间均显著长于SN组,术后苏醒即刻的躁动评分、躁动发生率和CHIPPS评分均显著低于SN组,差异均有统计学意义（P〈0.05）。两组患儿均未见明显不良反应发生。结论：在小儿扁桃体/腺样体切除手术中,右美托咪定作为全麻辅助用药,虽会使患儿术后拔管时间和睁眼时间延长,但可有效降低小儿麻醉术后躁动评分、躁动发生率和CHIPPS评分,利于患儿平稳度过术后苏醒期。

OBJECTIVE： To explore the preventive effects of dexmedetomidine on postoperative agitation of pediatric sevoflu- rane general anesthesia. METHODS： 41 children underwent amygdalectomy/adenoidectomy of general anesthesia were selected and randomly divided into SD group （21 cases） and SN group （20 cases）. Both groups received atropine 0.01 mg/kg, cisatracurium 0.15 mg/kg and 8% sevoflurane to induce anesthesia. After intubation, the lungs were clear and equivalent to auscultation bilateral- ly, and then both groups received mechanical ventilation and intravenous pump of remifentanil 0.15 μg/（kg.min）. After the operation began, SD group was given dexmedetomidine 0.5 μg/（kg·h）and SN group given normal saline 0.5 μg/（kg· h）via intravenous pump. At the end of operation, anesthetics was discontinued; the children respired autonomously, tidal volume retune to normal, and deglutition reflex and cough reflex recovered; an then the tube could be drawn. Heart rate （HR） and mean arterial pressure （MAP） of 2 groups were recorded before intravenous pump of dexmedetomidine （T2）, at 10 （T2）, 20 （T3）, 30 min （T4） after in-travenous pump, at the moment of extubation （T5）. Postoperative extubation time and opening eyes, the occurrence of ADR were observed in 2 groups. The degree of postoperative agitation and pain （CHIPPS score） were scored in 2 groups. RESULTS： Compared with before treatment, MAP and HR of SD group were decreased at different time points after treatment, but no change was found in SN group; there were statistical significance in MAP and HR between 2 groups at T2-T5 （P〈0.05）. Postoperative extubation time and opening eyes time of SD group were significantly longer than those of SN group, while agitation score immediately after operation, the incidence of agitation and CHIPPS score were significantly lower than SN group, with statistical significance （P〈0.05）. No obvious ADR was found in 2 groups. CONCLUSIONS： For pediatric amygdalectomy/adenoidectomy, dexmedetomidine as adjunctive drug of general anesthesia prolongs the time of postoperative extubation and opening eyes, but can effectively reduce postoperative agitation score, the incidence of agitation and CHIPPS score. It helps the children to feel more comfortable during anesthesia recovery period.