右美托咪啶对全麻患儿生命体征、七氟烷用量及术后不良反应的影响

Effects of dexmedetomidine on vital signs,sevoflurane dosage and adverse reactions after general anesthesia in children

目的探讨右美托咪啶对全麻患儿生命体征、七氟烷用量和术后躁动、恶心呕吐发生率的影响。方法选择四肢骨折愈合后手术取内固定3~10岁小儿60例,随机分为观察组和对照组各30例。观察组在七氟烷诱导前给予右美托咪啶0.5μg/kg于15 min内泵入,术中用0.2μg/(kg·h)泵入,在手术结束前0.5 h停药;对照组给予等量生理盐水。两组手术中均用麻醉深度监测仪监测麻醉深度,调整七氟烷浓度使脑电双频谱指数(BIS)控制在40~50。观察两组泵入右美托咪啶或生理盐水之前(T_0)、给予右美托咪啶或生理盐水15 min时(T_1)、插喉罩时(T_2)、手术开始(T_3)、手术10 min(T_4)、手术30 min(T_5)、手术结束时(T_6)各时间点的血压(SBP、DBP)、心率(HR)、BIS变化。比较两组术中七氟烷的用量、麻醉诱导时间、停药后清醒时间、苏醒时躁动程度及恶心呕吐发生情况。结果观察组SBP、DBP、HR在T_1~T_6多个时间点低于对照组(P均<0.05),但均控制在正常范围。与对照组相比,观察组麻醉诱导时间缩短,七氟烷用量减少,躁动、恶心呕吐发生率降低,差异均有统计学意义(P均<0.05)。结论右美托咪啶能减少全麻患儿七氟烷用量,降低患儿术后躁动、恶心呕吐发生率,且对患儿SBP、DBP、HR无明显影响。

Objective To evaluate the effects of dexmedetomidine on vital signs,sevoflurane dosage,postoperative ag-itation,nausea and vomiting after general anesthesia in children.Methods We selected 60 cases of 3 to 10-year-old chil-dren with removal of internal fixation of limbs fracture after recovery.All 60 cases are randomly divided into 2 groups：the observation group and control group.In the observation group at 0.5 mg/kg dexmedetomidine was pumped into children be-fore the induction of sevoflurane for 15 min,and 0.2 μg/（kg·h）was given during the operation,and we stopped the pumping at 0.5 h before the end of surgery.In the control group,the children were treated with normal saline instead of dexmedetomidine.BIS monitoring system was used in both groups during the operation,and we adjusted the concentration of sevoflurane to keep the BIS value between 40 and 50.We recorded the blood pressure （SBP,DBP）,heart rate （HR） and BIS in both groups before （T0 ）and 15min after pumping dexmedetomidine or saline （T1 ）,at the time of endotracheal intubation （T2 ）,0 min,10 min,20 min,30 min （T3-T6 ）after the operation began.The dosage of sevoflurane in the op-eration,the time of anesthesia induction,the awake time after stopping treatment,the degree of restlessness and the inci-dence of nausea and vomiting were compared between these two groups.Results Compared with the control group,the SBP,DBP and HR at T1 -T6 in the observation group was lower but was controlled in the normal range （all P 〈0.05）. Compared with the control group,the sevoflurane dosage during operation was reduced,the incidence of nausea and vomi-ting was decreased in the observation group,and significant difference was found （all P 〈0.05）.Conclusion Dexme-detomidine can reduce the sevoflurane dosage during operation and decrease the incidence of nausea and vomiting after gen-eral anesthesia in children and has no significant effects on SBP,DBP and HR of children.