全身麻醉复合使用不同剂量右美托咪定对苏醒期患儿咽喉反射及苏醒质量的影响

Effect of Combined Use of Different Doses of Dexmedetomidine in General Anesthesia on Laryngeal Reflex and Recovery Quality in Children with Recovery

目的探讨全身麻醉复合使用不同剂量右美托咪定(Dex)对患儿苏醒期咽喉反射及对苏醒质量的影响。方法选取择期行骨科、泌尿外科等手术的患儿120例,随机分为D1组(Dex1.0μg/kg)、D2组(Dex 0.5μg/kg)、D3组(Dex 0.25μg/kg)和C组(安慰剂组)。入室后给予七氟醚吸入诱导,置入喉罩;术中以空氧混合-七氟烷-芬太尼维持,全程保留自主呼吸。预计手术结束前30min,静脉恒速输注不同剂量Dex或等容积生理盐水(15min泵入)。手术结束时关闭七氟烷,深麻醉下拔除喉罩,置入鼻咽通气道保证患儿通气,直至苏醒。记录患儿苏醒后2min咽喉反射恢复质量评级;记录药物不良反应。结果 D3组在苏醒后2min咽喉反射恢复质量最高,明显优于D1组(P<0.05);D3组咽喉反射恢复速度最快,恢复时间显著短于D1组(P<0.01)、D2组(P<0.05)。术中使用Dex的患儿有一定比例发生低血压及心动过缓,D1组、D2组、D3组低血压的发生率显著高于C组(P<0.05),D1组、D2组心动过缓的发生率明显高于D3组(P<0.05)。结论全身麻醉患儿手术结束前30min给予右美托咪定0.25μg/kg可有效减少拔管期间心血管反应,使得苏醒更加平稳。

Objective To investigate the effects of general anesthesia combined with different doses of Dex on laryngeal reflex and awakening quality during recovery period in children. Methods Totally 120 children in Department of orthopedics and urology, randomly divided into group D1 （Dex1.0μg/kg）, group D2 （Dex 0.5μg/kg）, D3 group （Dex 0.25μg/kg） and C group （placebo group）.After inhalation, sevoflurane inhalation was induced, and laryngeal mask airway was inserted. During the operation, seven patients were maintained by air oxygen mixed with halofthane and fentanyl. Totally 30 minutes before the end of operation, Dex or equal volume of normal saline （15min pump） was injected intravenously at different doses. At the end of operation, seven halothane was closed. Under larynx anesthesia, the laryngeal mask airway was removed and the nasopharyngeal airway was inserted to ensure that the children were ventilated until they regained consciousness. The quality of 2 min laryngeal reflex recovery was recorded,records of adverse drug reactions. Results Patients in group D3 were associated with better and faster recovery of airway reflexes than patients in group D1 （P〈0.05）. Hypotension happened more frequently in group D1, D2, D3 than group C （P〈0.05）. Patients in group D3 underwent less bradycardia than patients in group D1 and D2 （P〈0.05）. Conclusion Dexmedetomidine of 0.25μg/kg may effectively control cardiovascular responses during emergence.