右美托咪定复合七氟烷在儿童口腔全麻治疗中的效果评价

Effect of dexmedetomidine combined with sevoflurane for general anesthesia during dental treatment in pediatric patients

目的 :观察右美托咪定复合七氟烷用于儿童口腔全麻治疗的疗效及其影响因素。方法 :将120例拟行口腔全麻治疗(>90 min)的患儿随机分为右美托咪定复合七氟烷组(D组)和七氟烷组(S组),每组60例。D组经面罩吸入4%~6%七氟烷,静脉推注芬太尼1μg/kg,咪唑安定0.1 mg,丙泊酚2 mg/kg,罗库溴铵0.3 mg/kg。待患儿睫毛反射消失后,进行气管插管,以2%~3%七氟烷吸入维持。手术开始时,泵注丙泊酚,速度为9~12 mg/(kg·h);同时先以1μg/kg速度泵注右美托咪定15 min后,减为0.5μg/(kg·h)维持直至手术结束。S组未泵注右美托咪定。监测患儿入室(T1)、睫毛反射消失(T2)、泵注右美托咪定10 min(T3)、手术开始(T4)、手术结束(T5)时的心率(HR)、平均动脉压(MAP)及Ramsay镇静评分,记录手术完成时间、手术后患儿苏醒时间、拔管时间、麻醉后恢复室(PACU)内小儿苏醒期躁动评分(PAED)。采用SPSS 20.0软件包对数据进行统计学分析。结果:2组手术完成时间比较差异无统计学意义;术中T3-T5时D组MAP、HR显著低于S组(P<0.05),Ramsay镇静评分显著高于S组(P<0.05);D组苏醒时间、拔管时间显著高于S组;在PACU内,D组小儿苏醒期PAED评分显著低于S组。结论:右美托咪定复合七氟烷用于儿童口腔全麻手术,患儿循环指标稳定,对呼吸影响小。虽然苏醒时间有所延长,但可提高苏醒质量。

PURPOSE： To evaluate the effect of dexmedetomidine combined with sevoflurane for general anesthesia during dental treatment in pediatric patients. METHODS： One hundred and twenty pediatric patients undergoing dental treatment were randomly divided into sevoflurane combined dexmedetomidine group（D group）and sevoflurane group（S group）, 60 children in each group. Children in group D inhaled 4%-6% sevoflurane and intravenously received fentanyl 1 μg/kg, midazolam 0.1 mg, propofol 2 mg/kg, rocuronium 0.3 mg/kg, then tracheal intubation was performed when eyelash reflex disappeared, the density of sevoflurane was reduced to 2%-3% for maintenance. When the treatment started, 9-12 mg/（kg·h） of propofol was pumped, and 1 μg/kg of dexmedetomidine was pumped for 15 minutes,then the dose was reduced to 0.5 μg/（kg ·h） until the end of treatment. Children in group S didn’t receive dexmedetomidine pumped. During the procedure, HR, MAP, and Ramsay scale were recorded at baseline（T1）, loss of eyelash reflex（T2）, after dexmedetomidine was pumped for 10 mins（T3）, operation initiation（T4） and the end of operation（T5）. The operation time, recover and extubation time, pediatric anesthesia emergence delirium scale（PAED） in pediatric anesthesia care unit（PACU） were recorded. SPSS 20.0 software package was used for statistical analysis. RESULTS：There was no significant difference in operation time between the two groups. At T3-T5, MAP and HR were significantly lower, but Ramsay scale was significantly higher in group D than in group S（P〈0.05）. The recover and extubation time were significantly longer in group D（P〈0.05）. In PACU, PAED scale was significantly lower in group D than in group S（P〈0.05）. CONCLUSIONS： Dexmedetomidine combined with sevoflurane not only stabilize hemodynamic parameters, but also reduce the impact on respiration during dental treatment in pediatric patients.