术前右美托咪定喷鼻对全凭七氟醚吸入麻醉行腹部外科手术患儿的脑电双频指数及七氟醚半数有效浓度的影响

Effects of preoperative intranasal Dexmedetomidine for the bispectral index and median effective concentration of Sevoflurane in children with abdominal surgery by inhalation anesthesia of Sevoflurane

目的分析术前右美托咪定喷鼻对全凭七氟醚吸入麻醉行腹部外科手术患儿的脑电双频指数(BIS)及七氟醚半数有效浓度[EC(50)]的影响。方法选取首都医科大学附属北京儿童医院2016年2月~2017年2月接受腹部外科手术的患儿120例,ASA分级Ⅰ~Ⅱ级,年龄1~3岁,采用随机数表法将其分为研究组和对照组,每组60例,分别在麻醉诱导前30 min采用经鼻雾化给药装置给患儿喷入右美托咪定2μg/kg和等量的生理盐水。患儿入手术室后,面罩加压给氧,吸入6%七氟烷诱导,意识消失后置入喉罩,按照Dixon序贯实验给药,初始浓度为3.50%,下1例患儿七氟醚的设定根据上1例患儿喉罩置入的情况调整。记录两组喷鼻前(T_0)、喷鼻后20 min(T_1)、手术结束(T_2)、麻醉恢复时(T_3)患儿血压、心率、BIS值变化及苏醒期躁动、不良反应发生情况,分析七氟醚喉罩置入时EC(50)与其95%置信区间(CI)。结果两组患儿在T_0、T_1时刻血压、心率比较差异无统计学意义(P>0.05),T_2、T_3时刻研究组患儿血压、心率均较对照组显著增快(P<0.05);两组患儿T_0时刻BIS值比较差异无统计学意义(P>0.05),T_1、T_2时刻研究组患儿BIS值较对照组显著降低(P<0.05),T_3时刻研究组患儿BIS值显著高于对照组(P<0.05)。研究组、对照组患儿七氟醚喉罩置入完成的EC(50)分别为1.35%(95%CI=1.05%~1.48%)、1.89%(95%CI=1.77%~2.18%),差异有统计学意义(P<0.05)。研究组患儿苏醒期躁动发生率为5.00%,显著低于对照组的18.33%(P<0.05),恶心、呕吐发生率为11.67%、6.67%,显著低于对照组的26.67%、21.67%(P<0.05)。结论术前右美托咪定喷鼻可减少腹部外科手术患儿七氟醚吸入麻醉后躁动,对改善七氟醚吸入麻醉质量、七氟醚EC(50)均有积极作用,并可有效减少不良反应。

Objective To analyze the effects of preoperative intranasal Dexmedetomidine for the bispectral index （BIS） and median effective concentration [EC （50）] of Sevoflurane in children with abdominal surgery by inhalation anesthesia of Sevoflurane. Methods One hundred and twenty children received abdominal surgery in Beijing Children′s Hospital, Capital Medical University from February 2016 to February 2017 were selected, with ASA grading Ⅰ-Ⅱ and 1-3 years old. They were divided into study group and control group by random number table method, with 60 cases in each group, they were respectively given Dexmedetomidine 2 μg/kg and equal amounts of normal saline by nasal aerosolization device at 30 min before anesthesia induction. After the children entered operating room, they were given mask oxygen-inspiration and inhalation of 6% Sevoflurane for anesthesia induction. The laryngeal mask was given after children lost consciousness, and they were given drugs according to Dixon sequential experiment, the initial concentration was 3.50%. The setting of Sevoflurane for the next child was adjusted according to the conditions of laryngeal mask insertion of last one child. The changes of blood pressure, heart rate, BIS and the conditions of emergence agitation, adverse reactions before nasal spray （T0）, 20 min after nasal spray （T1）, and at the end of surgery （T2）, recovery from anesthesia （T3） between the two groups were compared, the EC （50） and 95% confidence interval （CI） at the time of laryngeal mask insertion of Sevoflurane were analyzed. Results There were no significant differences of blood pressure and heart rate at T0 and T1 between the two groups （P 〉 0.05）. The blood pressure and heart rate of the study group at T2, T3 were significantly higher than those of the control group （P 〈 0.05）. There was no significant difference of BIS value between the two groups at T0 （P 〉 0.05）. At T1 and T2, BIS values of the study group were significantly lower than those of the control group （P 〈 0.05）. At T3, BIS value of the study group was significantly higher than that of the control group （P 〈 0.05）. The EC （50） at laryngeal mask insertion of Sevoflurane in the study group and the control group was 1.35% （95%CI = 1.05%-1.48%） and 1.89% （95%CI = 1.77%-2.18%）, the differences were statistically significant （P 〈 0.05）. The incidence of emergence agitation in the study group was 5.00%, which was significantly lower than that of control group （18.33%） （P 〈 0.05）, the incidence of nausea and vomiting was 11.67%, 6.67% respectively, which was significantly lower than those of control group （26.67%, 21.67%） （P 〈 0.05）. Conclusion Preoperative intranasal Dexmedetomidine can reduce the agitation after inhalation anesthesia of Sevoflurane in children with abdominal surgery, which has positive effects for improving the quality of inhalation anesthesia of Sevoflurane and EC （50） of Sevoflurane, and it can effectively reduce adverse reactions.