右美托咪定对小儿扁桃体腺样体切除术麻醉苏醒期躁动及拔管反应的影响

Effects of dexmedetomidine infusion on the emergence delirum and extubation reaction in pediatric adenotonsillectomy patients

目的探讨右美托咪定对小儿扁桃体腺样体切除术麻醉苏醒期躁动及拔管反应的影响。方法选取择期行扁桃体腺样体切除术患儿96例,按随机数字表法分为三组,每组32例,A组为右美托咪定低剂量组(0.1μg·kg^(-1)),B组为右美托咪定高剂量组(0.2μg·kg^(-1)),C组为对照组。A、B两组分别在全麻诱导前给予0.1μg·kg^(-1)和0.2μg·kg^(-1)静脉微泵灌注右美托咪定10 min,对照组泵注等容量生理盐水。分别测定泵注右美托咪定前(T0)、泵注后5 min(T1)、泵注后10 min(T2)、拔管时(T3)、拔管后1 min(T4)、拔管后5 min(T5)等时间点所有患儿的血流动力学指标,血清血糖和皮质醇含量,拔管、苏醒和手术时间,呛咳、躁动和疼痛评分及不良事件发生率。结果患儿术后在拔管(T3)及拔管1 min(T4)时与C组相比,A、B两组患儿平均动脉压(MAP)、心率(HR)、血清血糖和皮质醇浓度、呛咳、躁动和疼痛评分均显著下降,而血氧饱和度(SPO2)显著上升(P<0.05),但3组手术时间、拔管时间和苏醒时间及不良事件发生率差异无统计学意义(P>0.05);且与泵注前相比,除C组外,A、B两组之间各项指标差异无统计学意义。结论小剂量右美托咪定持续灌注能有效降低小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期躁动发生率,有效稳定血流动力学,而不抑制呼吸作用,也不延长麻醉苏醒时间,且可减少不良事件的发生率,这些效应与剂量无相关性。

Objective To investigate the effects of dexmedetomidine on the emergence delirum and extubation reaction in pediatric adenotonsillectomy patients.Methods Selected 96 pediatric adenotonsillectomy patients,which were assigned into three groups according to the random number table method （n=32）,A and B groups were given intravenous injection of 0.1 μg＆#183;kg-1 and 0.2 μg＆#183;kg-1 dexmedetomidine respectively for ten minutes in the control group （C group） before general intravenous anesthesia,while the control group was infused in an equal volume of saline.The hemodynamic indexes,serum glucose and cortisol,extubation,recovery and operation time,choking cough,restlessness and pain score and adverse event incidence at T0,T1,T2,T3,T4 and T5 for all candidates were measured.Results Compared with the C group,the HR,the concentration of serum glucose and cortisol,choking cough,restlessness and pain scores were significantly decreased,and SPO2 significantly increased for A and B groups at T3 and T4（P〈0.05）.While the incidence operation time,extubation time and recovery time and adverse events rate among three groups were not statistically significant （P〉0.05）.Compared with pre injection pump,except C group,there were no differences between A and B group for all indexes.Conclusions The lowdoses of dexmedetomidine of continuous perfusion can effectively reduce the occurrence rate of agitation in pediatric adenotonsillectomy patients by intravenous anesthesia,maintain the stability of hemodynamics and reduce the occurrence rate of adverse reaction,while it not inhibit respiration and prolong the anesthesia recovery time.These effects had no correlation with the dose of dexmedetomidine.