右美托咪啶复合地佐辛在小儿鼾症手术全身麻醉中对苏醒期的影响

Influence analysis of combined application of dexmedetomidine and dezocine on general anaesthesia operation of children's snoring during recovery period

目的分析右美托咪啶复合地佐辛在小儿鼾症手术全麻中对苏醒期的影响。方法选择3~7岁择期行扁桃体切除+腺样体切除的患儿80例,随机分成Ⅰ组(地佐辛+右美托咪啶组),Ⅱ组(地佐辛组),Ⅲ组(右美托咪啶组)和Ⅳ组(对照组),每组20例。记录4组患儿手术时间、拔管时间和入室时(T_0)、手术结束前5 min(T_1)、术毕(T_2)、拔管即刻(T_3)、拔管后5 min(T_4)、拔管后10 min(T_5)的血流动力学变化(HR、MAP)。同时采用儿童苏醒期躁动评分表(PAED)、儿童疼痛评分表(m-CHEOPS)和Ramsay镇静评分表记录拔管后10 min患儿的苏醒情况。结果4组患儿在T_0时的MAP、HR水平比较差异无统计学意义(P>0.05)。在Ⅳ组,T_3~T5时HR明显较T_0时增快,T_2~T5时的MAP较T_0时明显增高,差异均有统计学意义(P<0.05)。T_1~T5时Ⅰ组HR较Ⅱ、Ⅲ、Ⅳ组明显减慢,MAP明显降低,差异均有统计学意义(P<0.05)。Ⅰ组的儿童苏醒期躁动评分表(PAED)及儿童疼痛评分表(m-CHEOPS)分值均明显低于Ⅱ组、Ⅲ组、Ⅴ组,差异具有统计学意义(P<0.05)。Ⅰ组、Ⅱ组的Ramsay镇静评分均高于Ⅲ组、Ⅳ组,差异均有统计学意义(P<0.05)。结论在小儿鼾症手术中右美托咪啶及地佐辛可使全麻苏醒期血流动力学更加平稳,减少并发症的发生,降低拔管时应激反应,提高患儿苏醒期质量,值得临床推广应用。

Objective To analyse the influence of combined application of dexmedetomidine and dezocine on general anaesthesia operation of children＇s snoring during recovery period.Methods 80 children patients of three to seven years old,who were waited to selective operation of tonsillectomy and adenoidectomy,are randomly divided into four groups with 20 patients in each,They were Group Ⅰ（dezocine＋dexmedetomidine group）,Group Ⅱ（dezocine）,Group Ⅲ（dexmedetomidine group） and Group Ⅳ（control group）.The operation time,extubation time and hemodynamic changes（HR,MAP） respectively at the time of extubation and entering operation room（T0）,5 min before the end of operation（T1）,the end of operation（T2）,extubation time（T3）,5 min after extubation（T4） and 10 min after extubation（T5）.Meanwhile,pediatric anesthesia emergence delirium scale（PAED）,Modified Children＇s Hospital of Eastern Ontario Pain Scale（m-CHEOPS） and Ramsay Sadation Scale are adopted to record the recoveries of children patients after 10 minutes since extubation.Results There was no significant difference in MAP and HR among four groups in T0（P〉0.05）.In group IV,HR at T3~T5 were significantly faster than at T0,and the MAP at T2~T5 were significantly higher than that at T0,the differences were statistically significant（P〈0.05）.At T1~T5,HR and MAP of Group Ⅰ were significantly lower than group Ⅱ, group Ⅲ, group Ⅳ,the differences were statistically significant（P〈0.05）.PAED score and m-CHEOPS score of group Ⅰ were lower than those of group Ⅱ,group Ⅲ,group Ⅳ,the differences were statistically significant（P〈0.05）.The Ramsay sedation score of group Ⅰ and group Ⅱ were higher than those of group Ⅲ and group Ⅳ,the differences were statistically significant（P〈0.05）.Conclusion Combined application of dexmedetomidine and dezocine on general anaesthesia operation of children＇s snoring can stabilize hemodynamics during recovery period,reduce the possibility of complication,decrease stress responses of extubation and improve the recovery quality,which is worthy of clinical application.