右美托咪定在小儿腹腔镜腹股沟疝手术中的应用

Application of dexmedetomidine in pediatric laparoscopic inguinal hernia surgery

目的探讨右美托咪定在小儿腹腔镜腹股沟疝手术中对控制苏醒期躁动的作用。方法 40例接受腹腔镜腹股沟疝手术治疗的患儿作为研究对象,随机分为对照组和观察组,各20例。观察组在麻醉诱导前给予右美托咪定静脉注射,对照组在麻醉诱导前给予同等剂量的生理盐水。比较两组患儿的手术时间、麻醉时间、苏醒时间、心率(HR)、平均动脉压(MAP)、躁动发生率及躁动评分。结果两组患儿的手术时间、麻醉时间、苏醒时间对比,差异均无统计学意义(t=0.918、-0.276、-0.156,P>0.05)。给药后10 min(T_1)、术后麻醉清醒时(T_2)时间点时,观察组患儿的HR及MAP均低于对照组,差异均具有统计学意义(P<0.05);给药前(T_0)、拔管后5 min(T_3)时间点时,两组患儿的HR及MAP对比,差异均无统计学意义(P>0.05)。观察组发生苏醒期躁动2例(10.00%),躁动评分为(1.79±0.95)分;对照组发生苏醒期躁动8例(40.00%),躁动评分为(2.83±1.02)分。观察组苏醒期躁动发生率及躁动评分均低于对照组,差异均具有统计学意义(P<0.05)。结论右美托咪定在小儿腹腔镜腹股沟疝手术中可显著减少全身麻醉苏醒期躁动的发生,维持术中血流动力学稳定,可在临床中推广应用。

Objective To discuss the effect of dexmedetomidine on control of restlessness in recovery period during pediatric laparoscopic inguinal hernia surgery. Methods A total of 40 children undergoing laparoscopic inguinal hernia surgery as study subjects were randomly divided into control group and observation group, with 20 cases in each group. The observation group received dexmedetomidine intravenous injection before anesthesia induction, and the control group received same dose of normal saline before anesthesia induction. Comparison were made on operation time, anesthesia time, recovery time, heart rate（HR）, mean arterial pressure（MAP）, agitation rate and agitation score in two groups. Results Both groups had no statistically significant difference in operation time, anesthesia time, recovery time（t=0.918,-0.276,-0.156, P〉0.05）. At 10 min after administration（T1） and postoperative anesthesia consciousness（T2）, the observation group had lower HR and MAP than the control group, and the difference was statistically significant（P〈0.05）. Before administration（T0） and at 5 min after extubation, both groups had no statistically significant difference in HR and MAP（P〉0.05）. The observation group had 2 cases with restlessness in recovery period（10.00%）, and the restlessness score was（1.79±0.95） points, which were 8 cases（40.00%） and（2.83±1.02） points in the control group. The observation group had lower incidence of restless and restless score in recovery period than the control group, and the difference was statistically significant（P〈0.05）. Conclusion Dexmedetomidine can significantly reduce the emergence of restlessness during general anesthesia in pediatric laparoscopic inguinal hernia surgery, and maintain hemodynamic stability during operation. It can be clinically promoted and applied.