不同剂量右美托咪定复合丙泊酚用于学龄前儿童全麻肠镜检查的临床观察

A prospective randomized controlled study of different doses of dexmedetomidine with propofol used for preschool children in enteroscopy anesthesia

目的观察右美托咪定复合靶控输注丙泊酚用于学龄前儿童肠镜检查的临床效果。方法选取160例年龄4~6岁行门诊肠镜检查的患儿根据右美托咪定剂量不同随机分为四组:丙泊酚+右美托咪定0.8μg/kg(PD1)组、1.0μg/kg(PD2)组、1.2μg/kg(PD3)组和丙泊酚(PNS)组。各组右美托咪定均用生理盐水稀释至15 m L后于15 min输注完毕,PNS组予15 mL生理盐水输注。随后行丙泊酚靶控输注,达到效应室浓度后开始手术。记录手术及复苏过程中的生命体征,手术、苏醒及离开麻醉复苏室的时间并观察记录不良反应发生的例数。结果与PNS组相比,PD3组在术中HR明显降低(P<0.05);右美托咪定各组患儿术中体动和术后躁动发生率降低,PD2、PD3组手术时间缩短(P<0.05),但PD3组患儿苏醒和离开复苏室时间延长(P<0.05)。结论 1.0μg/kg右美托咪定复合丙泊酚靶控输注用于门诊学龄前儿童肠镜检查安全有效,苏醒平稳且不延长苏醒时间。

Objective To investigate the clinical effects of different dose dexmedetomidine with propofoltarget-control infusion in preschool children enteroscopy anesthesia. Methods One hundred and sixty scheduledout-patient preschool children with enteroscopy were randomly divided into four groups（n = 40 each）：propofolwith dexmedetomidine 0.8 μg/kg（group PD1）,1.0 μg/kg（group PD2）,1.2 μg/kg（group PD3）and propofol group（group PNS）. Dexmedetomidine was diluted in 15 mL normal saline then applied within 15 min. Normal saline inthe same volume were given at same speed in group PNS,followed by propofol given with target-control infusionfor all the children. SpO2,HR and MAP,the recovery time,time of leaving recovery room,the episodes of restless-ness in procedure and postoperative were recorded. Results Compared to group PNS,HR decreased（P〈0.05）in group PD3,the ratio of intraoperative and postoperative agitation were lower in another three groups;time of pro-cedural were shorter in both group PD2 and PD3,but time of recovery and leaving after procedure were longer ingroup P D3（P〈0.05）. Conclusion Dexmedetomidine 1.0 μg/kg with propofol provides better efficiency for anes-thesia,few perioperative respiratory depression and restlessness,without recovery time prolongedin ambulatory en-teroscopy anesthesia for preschool children.