地佐辛与右美托咪定用于小儿腹腔镜手术七氟烷全麻苏醒期躁动的刍议

Dezocine and Dexmedetomidine on Restlessness in Pediatric Laparoscopic Surgery Seven Halothane Anesthesia Recovery Period

目的探讨地佐辛与右美托咪定用于预防小儿腹腔镜手术七氟烷全麻苏醒期躁动和对血流动力学与呼吸的影响。方法方便选择该院2015年6月—2016年5月小儿腹腔镜手术90例,ASAⅠ或Ⅱ级,随机分为3组,每组30例,A组为地佐辛组,B组为右美托咪定组,C组为对照组。患儿入室后全部采用8%七氟烷诱导气管插管,术中维持采用2%~4%七氟烷和瑞芬太尼0.5~1μg/(kg·min)。手术结束前10 min,A组静脉缓慢推注地佐辛0.1 mg/kg,B组静脉泵注右美托咪定0.5 ug/kg·(10 min),C组静脉推注相同容量的生理盐水。分别记录3组患儿在麻醉恢复室的苏醒时间、停留时间,观察患儿进入恢复室时刻(T1)、拔管即刻(T2)、拔管后10 min(T3)的心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SpO_2)的变化,以及躁动评分和术后6 h镇痛评分。结果 3组患儿在恢复室的苏醒时间和停留时间差异无统计学意义(P>0.05),A组和B组在拔管即刻的HR(80±6.3)次/min、(68±3.5)次/min和MAP(8.9±0.2)KPa、(8.5±0.3)KPa变化较小,与C组(99±1.9)次/min、(11.2±0.9)KPa比较差异有统计学意义(P<0.05),而且B组心率更慢,3组Sp O2差异无统计学意义,A、B两组的躁动评分(1.5±0.6)分、(1.6±0.4)分明显小于C组(3.9±0.7)分,A、B的躁动发生率(10.0%、6.7%)明显低于C组(56.7%),术后6 h镇痛效果A组更好。结论地佐辛与右美托咪定可安全用于预防小儿腹腔镜手术七氟烷全麻苏醒期躁动,而且血流动力学稳定,对呼吸没有影响,地佐辛镇痛效果更强。

Objective This paper tries to observe the effect of dezocine and dexmedetomidine for prevention of pediatric laparoscopic surgery and on hemodynamics and respiratory agitation of seven isoflurane anesthesia recovery period.Methods In this hospital from June 2015 to May 2016 were convenient selected of pediatric laparoscopic surgery in 90 cases,ASA grade I or II,were randomly divided into three groups,with 30 cases in each group,group A of dezocine group,group B for dexmedetomidine,group C as control group.All the children were intubated by 8%sevoflurane induced tracheal intubation after entering the room.The patients were maintained with 2%~4%,seven halothane and remifentanil 0.5~1μg/(kg·min).10min before the end of surgery,group A intravenous injection of dezocine 0.1 mg/kg,group B intravenous infusion of dexmedetomidine 0.5μg/kg·(10 min),group C intravenous injection of saline of the same volume.The PACU recovery time,residence time in three groups were recorded,the children into the recovery room time(T1),extubation(T2),10min after extubation(T3)heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SpO2)changes,and the agitation score and postoperative 6h score were observed.Results The three groups were no significantly different in the recovery time and recovery room residence time(P>0.05),group A and group B in the HR tube after pulling(80±6.3),(68±3.5)times/min and MAP(8.9±0.2),(8.5±0.3)KPa and significantly different from group C(99±1.9),(11.2±0.9)KPa(P<0.05),and group B heart rate more slowly,the three groups had no difference between the groups A and B of SpO2,agitation of the scores of two groups(1.5±0.6)points,(1.6±0.4)points,lower than that of C group(3.9±0.7)points,the incidence of agitation of group A and B were(10.0%,6.7%),significantly lower than that of group C(56.7%),6 h postoperative analgesic effect of group A was better.Conclusion Dezocine and dexmedetomidine is safe for prevention of pediatric laparoscopic surgery in seven halothane agitation during the recovery period of general anesthesia,and hemodynamic stability,without influence on respiration,with stronger dezocine analgesia.