右美托咪啶复合复方利多卡因乳膏对小儿扁桃体切除术拔管反应的影响

Effection of combining dexmedetomidine with lidocaine cream on response to tracheal extubation in pediatric tonsillectomy

目的观察右美托咪啶复合复方利多卡因乳膏对小儿扁桃体切除术拔管反应的影响。方法选取2016年1至6月兰州大学第二医院择期行扁桃体切除术患儿80例，采用随机数字表法分为对照组（C组）、右美托咪啶组（D组）、复方利多卡因乳膏组（L组）、右美托咪啶＋复方利多卡因乳膏组（R组），每组20例。D组和R组在诱导后静脉泵注右美托咪啶1μg／kg，L组和C组静脉给予等量生理盐水；L组和R组在气管导管前1／3涂抹复方利多卡因乳膏，D组和C组在气管导管相同部位涂抹等量石蜡油。记录入室后（，ID）、拔管前（T1）、拔管即刻（T2）、拔管后1min（13）、拔管后5min（T4）、拔管后10min（T5）6个时点的心率（HR）、收缩压（SSP）、舒张压（DBP）、SPO2；记录术毕至自主呼吸恢复时间、拔管时间以及拔管时呛咳、躁动及术后不良反应发生率。结果拔管期间D组在T1、T2、T3时点的HR分别为（86．70±6．53）、（89．30±4．93）、（86．00±4．05）次／min，L组分别为（90．35±6．60）、（91．20±6．44）、（90．20±5．43）次／min，R组分别为（85．70±8．67）、（88．10±8．75）、（86．95±7．73）次／min，C组分别为（96．15±10．16）、（97．75±10．93）、（94．35±7．26）次／min，D组、L组和R组的HR明显低于C组，差异均有统计学意义（F=6．754、5．655、7．191，P均〈0．05）D、L组和R组的呛咳评分分别为（1．80±0．70）、（1．55±0．69）、（1．25±0．44）分，均明显低于C组的（2．45±1．05）分，差异有统计学意义（F=0．614，P〈0．05），R组的呛咳评分明显低于D组（P〈0．05）。D组和R组的躁动评分分别为（1．95±0．83）、（1．75±0．72）分，明显低于C组的（2．90±1．21）分，差异有统计学意义（F=9．245，P〈0．05），D组和R组躁动发生率分别为20％、15％，明显低于C组的60％，差异有统计学意义（Х^2=21．554，P〈0．05）。结论右美托咪啶联合复方利多卡因乳膏用于小儿扁桃体切除术可有效减轻拔管期应激及呛咳反应。

Objective To evaluate the effects of combining dexmedetomidine with lidocaine cream on extubation reaction in pediatric tonsillectomy. Methods Eighty children scheduled for tonsillectomy from January to June 2016 in the Lanzhou University Second Hospital, were randomly divided into group C （controll group ）, group D （dexmedetomidine group ）, group L （lidocaine cream group ）and group R （combing dexmedetomidine with lidocaine group） by digital random table method （n =20）. In group D and R, dexmedetomidine 1 μg/kg was injected intravenously after general anesthesia induction, and the same volume of normal saline was given in group L and C. Meanwhile, the children in group L and R were intubated with endotracheal tube coated with compound lidocaine cream at first third, while the children were intubated with endotracheal tube coated with liquid paraffin in group D and C. Heart rate （ HR）, systolic blood pressure（ SBP）, diastolic blood pressure（DBP） and saturation of pulse oximetry（ SPO2 ） were recorded at the time of baseline （ TO ）, before （ T1 ） and immediately （ T2 ） extubation, 1 （ T3 ）, 5 （ T4 ）, 10 （ T5 ） minutes after extubation. The time of spontaneous breathing recovery and extubation were recorded. Cough score, agitation score and adverse reactions were evaluated during the peri-extubation period. Results During extubation, HR were （86. 70 ± 6. 53）, （89. 30 ± 4. 93 ）, （86. 00 ± 4. 05 ） beats per minute at T1, T2, T3 respectively in group D, and they were （90. 35 ±6. 60） , （91.20 ±6.44） , （90. 20 ±5.43） beats per minute in group L and were （85.70 ±8. 67）, （88.10 ±8.75）, （86.95 ±7.73） beats per minute in group R. HR were （96. 15 ± 10. 16）, （97.75 ± 10. 93 ）, （94. 35 ± 7. 26） beats per minute at T1, T2, T3 respectively in group C. HR were significantly lower in group D, R and L than that in group C at T1, T2, T3 （ F = 6. 754, 5. 655,7. 191, all P 〈 0.05）. Cough score were （ 1.80 ± 0. 70）, （ I. 55 ± 0. 69）, （ 1.25 ± 0. 44） in group D, L and R respectively. All of them were significantly lower than that in group C （ 2.45 ± 1.05 ） （ F = 0. 614, P 〈 0. 05 ）. Cough score were significantly lower in group R than that in group D （ P 〈 0.05 ）. Agitation score were （ 1.95 ± 0. 83 ）, （ 1.75 ± 0. 72 ） in group D and R respectively, and they were significantly lower than that in group C （2. 90 ± 1.21 ） （ F = 9. 245, P 〈 0. 05 ）. Agitation incidence were 20% , 15% respectively in group D and R, and they were significantly lower than that in group C（60% ） （Х^2 = 21. 554, P 〈 0. 05 ）. Conclusion Combining dexmedetomidine with lidoeaine cream can effectively alleviate stress and cough reaction during extubation in pediatric tonsillectomy.