盐酸右美托咪定联合七氟烷对小儿眼科手术术后镇静的影响

Effect of dexmedetomidine combined with sevoflurane on postoperative sedation for children undergoing ophthalmic operation

目的探讨右美托咪定联合七氟烷对小儿眼科手术术后镇静的影响。方法选择2014年1月—2016年8月在安康市中医医院进行眼科手术的患儿200例,将其随机分为两组,每组100例,A组患儿接受七氟烷联合生理盐水术后镇静,B组患儿接受七氟烷联合右美托咪定术后镇静,比较两组患儿的手术情况以及术后VAS疼痛评分、Ramsay镇静评分以及PAED躁动评分,记录两组患儿术后不良反应的发生情况并进行统计学分析。结果两组患儿的手术时间差异不显著,B组患儿术后清醒较A组晚,差异有统计学意义(P<0.05)。B组患儿术后拔管质量评分低于A组,差异有统计学意义(P<0.05);且B组术后使用镇痛剂的患儿明显较A组少,差异有统计学意义(P<0.05)。T1、T2及T3时刻,B组患儿的VAS评分显著小于A组患儿,差异有统计学意义(P<0.05);T1及T2时B组患儿的Ramsay评分显著高于A组患儿,差异有统计学意义(P<0.05);B组患儿PAED评分明显低于A组,差异有统计学意义(P<0.05)。B组患儿术后恶心呕吐、呼吸抑制、术后躁动的发生率显著低于A组患儿,差异有统计学意义(P<0.05);且B组患儿术后发生不良反应的总发生率显著低于A组患儿,差异有统计学意义(P<0.05)。结论右美托咪定联合七氟烷用于小儿眼科手术术后镇静的临床疗效显著且安全性较好,可以显著缓解患儿苏醒期的躁动程度,降低患儿术后发生不良反应的发生率,值得临床推广应用。

Objective To explore the effect of dexmedetomidine combined with sevoflurane on the postoperative sedation for children undergoing ophthalmic operation. Methods Pediatric patients(200 cases) in Ankang Hospital of Traditional Chinese Medicine from January 2014 to August 2016 were enrolled, of which patients were divided into two groups randomly, Group A(n = 100) accepted sevoflurane combined with normal saline, and Group B(n = 100) adopted sevoflurane combined with dexmedetomidine. The operative conditions and postoperative VAS, Ramsay and PEAD scores were evaluated, and the postoperative adverse reactions were recorded and analyzed. Results There was no significance of the operation time between two groups, the wakened time of Group B was later than that of Group A significantly(P < 0.05), the postoperative extubation quality score of Group B was lower than that in Group A(P < 0.05), and the times of using analgesic in Group B was fewer than that of Group A(P < 0.05); The VAS score of patients in Group B was significantly lower than that of Group A at the time points of T1, T2 and T3; At the time points of T1 and T2, the Ramsay score of patients in Group B was higher than that in Group A, and PAED score of Group B was lower than that in Group A, with significant difference between Groups A and B(P < 0.05); The incidence of nausea and vomiting, respiratory depression, postoperative agitation of patients in Group B was lower significantly than that of Group A, and the incidence of total adverse reactions in Group B was also lower than that in Group A significantly(P < 0.05). Conclusion The clinical efficacy and safety of dexmedetomidine combined with sevoflurane for patients undergoing ophthalmic operation are remarkable and deserve popularization in clinic, which not only relieves the restlessness agitation of patients in recovery period, but also decreases the incidence of adverse reactions.