右美托咪定和氯胺酮在小儿扁桃体切除术中的作用

The effect of dexmedetomidine and ketamine on tonsillectomy in children

目的观察比较右美托咪定、氯胺酮对小儿扁桃体切除术麻醉苏醒期躁动和镇痛的效果。方法选择ASAⅠ~Ⅱ级择期行扁桃体及腺样体切除术的患儿60例作为研究对象,随机分成P、D、K共3组,术中分别给予适量的安慰剂、右美托咪定、氯胺酮,记录3组患儿在麻醉前(T_0)、拔管时(T_1)、拔管后5 min(T_2)、10 min(T_3)、15 min(T_4)、30 min(T_5)的平均动脉压(MAP)和心率(HR),统计3组患儿的苏醒时间、恶心呕吐情况、躁动评分和疼痛评分等。结果在T_1、T_2、T_3时,D组和K组的MAP和HR均较P组更加稳定(P<0.05);D组、K组躁动评分、躁动发生率、恶心呕吐发生率均低于P组,且D组低于K组(均P<0.05)。结论右美托咪定和氯胺酮在麻醉苏醒期均能起到一定的镇痛作用,并能降低麻醉苏醒期躁动、恶心呕吐不良的发生和疼痛评分,且右美托咪定抑制躁动和恶心呕吐不良率的发生效果更明显。

Objective To observe and contrast the effects of dexmedetomidine and ketamine on the restlessness and analgesia during recovery period of anesthesia after tonsillectomy in children. Methods Sixty ASA Ⅰ-Ⅱ child patients underwent tonsillectomy and adenoidectomy were randomly divided into three groups, group P （appropriate amount of placebo was given in the operation）, group D （dexmedetomidine） and group K （ketamine）. Data of mean arterial pressure and heart rate of three groups were documented before anesthesia （T0）, during extubation （T1）, 5 min （T2）, 10 min （T3）, 15 min （T4） and 30 min （T5） after extubation were recorded. The analepsia time, adverse reactions, restlessness score and pain score were collected in three groups of patients. Results Compared with group P, values of mean arterial pressure and heart rate were more stable at T1, T2 and T3 in groups D and K （P〈0.05）. The restlessness score, incidence of restlessness and adverse reactions were lower in groups D and K than those in group P （P〈0.05）, and which were lower in group D than those of group K （P〈0.05）. Conclusion Both dexmedetomidine and ketamine can play an analgesic role in recovery period of anesthesia and reduce restlessness, adverse reactions and pain score in child patients. Moreover, dexmedetomidine is more effective on inhibiting restlessness and adverse reactions.