预防小儿包皮手术术后躁动右美托咪定最佳剂量的研究

Study on Optimal Dosage of Dexmedetomidine for Preventing Postoperative Agitation in Pediatric Circumcision

目的:探究右美托咪定预防小儿包皮手术术后躁动的最佳使用剂量。方法:选取2016年7月-2017年7月本院收治的择期小儿包皮环切术患儿180例。按照随机数字表法将其分为A、B、C、D、E、F(对照组)组,各30例。A组单次静脉注射右美托咪定0.2μg/kg,B组单次静脉注射右美托咪定0.3μg/kg,C组单次静脉注射右美托咪定0.4μg/kg,D组单次静脉注射右美托咪定0.5μg/kg,E组单次静脉注射右美托咪定0.6μg/kg,F组注射氯化钠注射液。观察各组用药前后HR、RR及SpO_2水平、进入术后恢复室(PACU)后各时间点的躁动情况、回到病房后各时间点的疼痛和镇静情况。结果:用药后,A、F组HR均高于用药前及B^E组(P<0.05),B^E组均较用药前下降(P<0.05);进入PACU后20、25、30 min,A组躁动评分均显著高于B^E组,比较差异有统计学意义(P<0.05);回到病房2、6 h,A组疼痛评分均高于B^E组(P<0.05);回到病房1、2 h,F组镇静评分均低于A^E组,且A组镇静评分均低于B^E组,比较差异有统计学意义(P<0.05)。结论:0.3~0.6μg/kg剂量的右美托咪定可有效对抗氯胺酮引起的心率加快,在预防小儿包皮手术术后躁动及镇痛镇静中具有较好的效果。

Objective:To explore the optimal dosage of Dexmedetomidine for preventing postoperative agitation in pediatric circumcision.Method:A total of 180 patients with selective circumcision from July 2016 to July 2017 in our hospital were selected,according to the random digital table method,they were divided into group A,B,C,D,E,F(the control group),30 cases in each group.Group A received a single intravenous injection of Dexmedetomidine 0.2μg/kg,group B received a single intravenous injection of Dexmedetomidine 0.3μg/kg,group C received a single intravenous injection of Dexmedetomidine 0.4μg/kg,group D received a single intravenous injection of Dexmedetomidine 0.5μg/kg,group E received a single intravenous Dexmedetomidine 0.6μg/kg,group F was injected with Sodium Chloride Injection.The levels of HR,RR and SpO2 before and after the medication,the agitation of each time point after PACU,and the pain and sedation at each time point after returning to the ward in each group were compared.Result:After medication,HR in group A and F were higher than those of before medication and group B-E(P<0.05),and group B-E were lower than those of before medication(P<0.05).After entering PACU 20,25,30 min,the agitation scores in group A were significantly higher than those of group B-E,the differences were statistically significant(P<0.05).After returning to the ward 2,6 h,the pain scores in group A were higher than those of group group B-E(P<0.05),after returning to the ward 1,2 h,the score of sedation in group F was lower than that of group A-E,and group A was lower than that of group B-E,the differences were statistically significant(P<0.05).Conclusion:Dexmedetomidine at a dosage of 0.3-0.6μg/kg can effectively counteract the increase of heart rate caused by Ketamine,has a good effect in preventing postoperative agitation and analgesia and sedation in children with circumcision.