右美托咪定在小儿腹腔镜疝囊高位结扎手术麻醉中的应用

Clinical applications of dexmedetomidine during pediatric laparoscopic high-ligation of hernial sac

目的观察右美托咪定在小儿腹腔镜疝囊高位结扎术中应用效果。方法择期行腹腔镜疝囊高位结扎术的患儿42例,随机分为常规麻醉组+右美托咪定组(D组)和常规麻醉组(C组),每组21例。记录置入喉罩前(T_(1))、置入喉罩即刻(T_(2))和置入喉罩结束(T_(3))3个时间点的心率(HR)和平均动脉压(MAP)。观察并记录拔除喉罩的时间、停留在麻醉恢复室(PACU)的时间和手术后的躁动情况。结果 D组T_(2)时间点MAP高于T_(1)和T3时间点(F=21.75,P<0.001),而HR T_(2)与T_(1)和T3时间点比较没有统计学差异(F=2.76,P=0.07);C组T_(2)时间点MAP高于T_(1)和T3时间点(F=21.53,P<0.001),HR高于T_(1)和T3时间点(F=46.30,P<0.001),D组T_(2)的HR低于C组T_(2)的HR(t=4.32,P=0.001)。D组拔除喉罩的时间长于C组(t=3.35,P=0.002),两组停留在PACU的时间相似(t=0.17,P=0.97)。D组手术后的躁动评分明显低于C组(t=-2.70,P=0.01)。结论右美托咪定可以减少小儿腹腔镜疝囊高位结扎术中麻醉置入喉罩时心率的波动,明显减少术后的躁动,提高苏醒质量。

Objective To observe the effects of dexmedetomidine during pediatric laparoscopic highligation of hernial sac.Methods Forty-two children undergoing laparoscopic high-ligation of hernial sac were randomly divided into dexmedetomidine group（D）and conventional anesthesia group（C）（n=21 each）.The values of heart rate（HR）and mean arterial pressure（MAP）over 3 time points of pre-intubation（T1）,LMA immediately（T2）and LMA（T3）were recorded along with durations of removing laryngeal mask,stay in anesthesia recovery room（PACU）time and postoperative restlessness.Results In group D,MAP athigher than those atT3（F=21.75,P〈0.001）and HR were not statistically significant atT3（F=2.76,P=0.07）;in group C,MAP athigher than those atT3（F=21.53,P〈0.001）,HR was higher than those atT3（F=46.30,P〈0.001）,HR atlower in group D than that in group C（t=4.32,P=0.001）.And group D was longer than group C（t=3.35,P=0.002）.Two groups were similar in time of PACU（t=0.17,P=0.97）.And postoperative agitation score was significantly lower in group D than that in group C（t=-2.7,P=0.01）.Conclusion Dexmedetomidine may reduce the anesthetic fluctuation of heart rate,minimize postoperative agitation and improve quality of recovery during pediatric laparoscopic high-ligation of hernia sac.