右美托咪定对不同人格特征学龄儿童七氟烷麻醉应激反应的影响

Effect of dexmedetomidine on stress reaction caused by sevoflurance anesthesia in schoolage children with different personality characteristics

目的:观察右美托咪定对不同人格特征患儿七氟烷麻醉围麻醉期应激反应的影响。方法:选取我院择期经脐单孔腹腔镜疝内环结扎术手术患儿160例,随机分为右美托咪定组(D组)及咪达唑仑组(M组),各80例;术前对所入选患儿进行艾森克人格测试(儿童版),并根据测试结果将患儿分为情绪型组(Ⅰ组)及稳定型组(Ⅱ组);DⅠ组44例;DII组36例;MⅠ组41例,MⅡ组39例。手术均在七氟烷吸入麻醉下完成,DⅠ、DⅡ组患儿于建立静脉后即刻泵注含1μg/kg DEX的生理盐水稀释液10mL;MⅠ,MⅡ组于同样时间点静脉泵注含0.05mg/kg咪达唑仑的生理盐水稀释液10mL,泵注时间均为15min。记录各组术前1d(T_0)、麻醉诱导前即刻(T_1)、建立气腹后1min(T_2)、拔喉罩时即刻(T_3)、出恢复室即刻(T_4)的MAP、HR;分别于术前1d及术后4h抽血6mL,采用生化法测定血糖浓度,采用放免法测定皮质醇、IL-6水平。结果:DⅠ组、MⅠ组MAP T_1,T_2,T_3,T_4较T_0升高(P<0.05);DⅡ组T_2,T_3较T_0升高(P<0.05);MⅡ组T_2,T_3,T_4较T_0升高(P<0.05);与DⅠ组比较,DⅡ组T_1,T_2,T_3MAP降低(P<0.05),MⅠ组T_2,T_3,T4MAP升高(P<0.05),MⅡ组T1MAP降低(P<0.05);与DⅡ组比较,MⅠ、MⅡ组T_2,T_3,T_4MAP升高(P<0.05);T_1,T_2,T_3,T4HR较T_0升高(P<0.05);与DⅠ组比较,DⅡ组T_1,T_2,T_3HR降低(P<0.05),MⅠ组各时点HR升高(P<0.05);MⅡ组T1HR降低,T2,T3,T4HR升高(P<0.05);与DⅡ组比较,MⅠ各时点HR均升高(P<0.05);MⅡ组T_2,T_3,T_4 HR升高(P<0.05);除DⅡ组外,各组患儿血糖、皮质醇、IL-6水平较术前均升高(P<0.05);与DⅠ组比较,DⅡ组T_1血糖、皮质醇降低(P<0.05),MⅠ、MⅡ组T_1患儿血糖、皮质醇、IL-6水平均升高(P<0.05);与DⅡ组比较,MⅠ、MⅡ组患儿血糖、皮质醇、IL-6水平均升高(P<0.05)。结论:盐酸DEX应用于七氟烷麻醉患儿,可有效抑制手术刺激引起的交感神经系统兴奋,减轻应激反应,维持血液动力学的稳定,利于儿童术后康复。

Objective：To observe the effect of dexmedetomidine on the stress reaction caused by sevoflurance anesthesia during the perianesthesia period in school-age children with different personality characteristics.Methods：A total of 160 children who were admitted in our hospital for transumbilical single-port laparoscopic hernia inner ring ligation were included in the study and randomized into dexmedetomidine（D）group and midazolam（M）group with 80 cases in each group.The children were performed with Eysenck Personality Questionnaire before operation（children edition）.According to the test results,the children were divided into the emotion group（groupⅠ）and stable group（groupⅡ）;44 in group DⅠ,36 in group DⅡ,41 in group MⅠ,and 39 in group MⅡ.The operation was performed under sevoflurance inhalation anesthesia.After establishing the venous channel,the patients in DⅠand DⅡ groups were given pumping injection of 10 mL normal saline diluent containing 1ug/kg DEX,while the patients in MⅠ and MⅡ groups were given pumping injection of 10 mL normal saline diluent containing 0.05mg/kg midazolam,for 15 min.MAP and HR one day before operation（T0）,before anesthesia induction（T1）,1min after pneumoperitoneum establishment（T2）,the time after pulling out the laryngeal mask（T3）,and the time after shifting from the recovery room（T4）were recorded.A volume of 6mL venous blood 1d before operation and 4h after operation was collected.The biochemical method was used to detect the blood sugar concentration.The radioimmunoassay was used to detect cortisol and IL-6 levels.Results：MAP at T1,T2,T3,and T4 in DⅠ and MⅡ groups were significantly elevated when compared with at T0（P〈0.05）.MAP at T2 and T3 in DII group was significantly elevated when compared with at T0（P〈0.05）.MAP at T2,T3,and T4 in MⅡ group was significantly elevated when compared with at T0（P〈0.05）.When compared with DⅠ group,MAP at T1,T2,and T3 in DⅡ group was significantly reduced（P〈0.05）;MAP at T2,T3,and T4 in MⅠgroup was significantly elevated（P〈0.05）;MAP at T1 in MⅡ group was significantly reduced（P〈0.05）.When compared with DⅡ group,MAP at T2,T3,and T4 in MⅠ and MⅡ groups was significantly elevated（P〈0.05）.HR at T1,T2,T3,and T4 was significantly elevated when compared with at T0（P〈0.05）.When compared with DⅠ group,HR at T1,T2,and T3 in DⅡ group was significantly reduced（P〈0.05）;HR at each timing point in MⅠ group was significantly elevated（P〈0.05）;HR at T1 in MⅡ group was significantly reduced,while at T2,T3,and T4 was significantly elevated（P〈0.05）.When compared with DⅡ group,HR at each timing point in MⅠ group was significantly elevated（P〈0.05）;HR at T2,T3,and T4 in MⅡ group was significantly elevated（P〈0.05）.Except for DⅡ group,the blood sugar,cortisol,and IL-6 levels were significantly elevated when compared with before operation（P〈0.05）.When compared with DⅠ group,the blood sugar and cortisol levels at T1 in DⅡ group were significantly reduced（P〈0.05）;the blood sugar,cortisol,and IL-6 levels at T1 in MⅠ and MⅡ groups were significantly elevated（P〈0.05）.When compared with DⅡ group,the blood sugar,cortisol,and IL-6 levels at T1 in MⅠ and MⅡ groups were significantly elevated（P〈0.05）.Conclusions：Application of hydrochloric DEX in sevoflurance anesthesia in children can effectively inhibit the excitability of sympathetic nervous system caused by operation,alleviate the stress reaction,and maintain the stability of hemodynamics,which is benefit for the postoperative rehabilitation.