术前右美托咪定滴鼻联合氯胺酮口服在患儿全麻腹腔镜腹股沟疝高位结扎术中的应用

目的探讨术前右美托咪定滴鼻联合氯胺酮口服用于患儿全麻腹腔镜腹股沟疝高位结扎术围麻醉期的镇静及预防术后躁动的临床效果。方法选择2017年1月至10月期间择期在全身麻醉下进行腹腔镜腹股沟疝高位结扎术的2~6岁患儿90例，随机分为3组，术前30min分别鼻内滴右美托咪定25μg／kg（D组），鼻内滴右美托咪定2μg／kg和口服氯胺酮3mg／k（DK组），口服氯胺酮6mg／kg（K组）。给药30min后评估惠儿的镇静评分、静脉穿刺抵抗评分、与父母分离时的情绪评分；观察并记录术后30min、1h、2h的躁动评分以及不良反应的发生情况。结果DK组患儿的镇静评分、静脉穿刺抵抗评分、与父母分离时的情绪评分均优于D组和K组（P〈0．05），DK组患儿的拔管时间较D组、K组长（P〈0．05），术后30min、术后1h、术后2h的躁动评分均低于D组、K组（P〈0．05），三组出麻醉恢复室时间差异无统计学意义（P〉0．05）。结论右美托咪定和氯胺酮的联合应用可产生明确的镇静作用，有助于患儿顺利接受麻醉诱导，围麻醉期不良事件较少，是用于临床实践的合理选择。

Objective To observe the clinical effect of preoperative intranasal dexmedetomidine and oral ketamine on sedation and preventing postoperative agitation in pediatric general anesthesia for inguinal hernia operation. Methods A total of 90 children, aged 2-6 years who were scheduled for inguinal hernia operation and American Society of Anesthesiologists status I - II, were randomly allocated to receive intranasal dexmedetomidine 2.5 μg/kg （ group D ） , oral ketamine 3mg/kg and intranasal dexmedetomidine 2μg/kg （ group DK ） , or oral ketamine 6 mg/kg （ group K ） 30 min before surgery. The sedation score, intravenous resistance score, emotion score when separating from their parents were evaluated at 30 rain after medication. Furthermore the agitation scores were observed and recorded at postoperative 30 min, 1h, 2h. Results The sedation score, intravenous resistance score, emotion score when separating from their parents in the DK group were superior to the other group （ P〈0.05 ） . The agitation score at each points were lower than those in the other group （ P〈0.05 ） . Conclusion The combination of intranasal dexmedetomidine 2μg/kg and oral ketamine 3mg/kg produces satisfactory separation from parents, allowing children to smoothly accept induction of general anesthesia.