不同剂量右美托咪定对小儿全麻苏醒期肌力恢复时间和躁动的影响

Effects of different doses of dexmedetomidine on recovery time of muscle strength and restlessness at stage of analepsia in children patients undergoing general anesthesia for tonsillectomy

目的观察不同剂量右美托咪定用于小儿扁桃体手术全麻苏醒期对肌力恢复和躁动的影响。方法选择择期行扁桃体手术患儿80例,年龄3～8周岁,ASAⅠ～Ⅱ级,采取随机数字表法将其随机分为NS组(0.9%氯化钠溶液对照组);DL组(右美0.2μg/kg);DM组(右美0.4μg/kg);DH组(右美0.6μg/kg),每组20例,手术结束前10 min,DL、DM和DH组分别给予相应剂量的右美托咪定静脉泵注,NS组给予同等容量的0.9%氯化钠溶液静脉泵注,均在10 min内泵注完毕。应用4个成串刺激法,记录肌力25%恢复的时间(T25)、50%的恢复时间(T50)、75%的恢复时间(T75)、90%的恢复时间(T90)。记录到达恢复室即刻(Tp0),5 min(Tp5),10 min(Tp10),25 min(Tp25),40 min(Tp40)躁动评分。结果与NS组比较,DH组T25、T50、T75和T90时间显著延长,差异有统计学意义(P<0.05);DL组、DM组T25、T50、T75和T90时间差异无统计学意义(P>0.05)。与NS组比较,DH组和DM组在Tp0,Tp5,Tp10,Tp25时PAED评分>15分的发生率降低(P<0.05),在Tp40时刻差异无统计学意义(P>0.05);DL组各时间点差异均无统计学意义(P>0.05)。结论小儿全麻苏醒期应用0.6μg/kg的右美托咪定使患儿肌力恢复时间延长,但可降低苏醒期躁动发生率;应用0.4μg/kg的右美托咪定对肌力恢复时间无明显影响,且可降低苏醒期躁动发生率;应用0.2μg/kg的右美托咪定对肌力恢复时间及苏醒期躁动发生率无明显影响。

Objective To observe the effects of different doses of dexmedetomidine on recovery time of muscle strength and restlessness at stage of analepsia in children receiving general anesthesia for tonsillectomy.Methods Eighty children patients aged 3~8years at ASA gradeⅠ~Ⅱwere randomly divided into four groups according to random digital table,NS group with 0.9%sodium chloride solution,DL group with dexmedetomidine 0.2μg/kg,DM group with dexmedetomidine 0.4μg/kg and DH group with dexmedetomidine 0.6μg/kg,with 20 patients in each group.The patients in DL group,Dmgroup and DH group were given dexmedetomidine by intravenous pump infusion in different doses at 10min before the end of operation,however,the patients in NS group were given the same volume of 0.9%sodium chloride solution by intravenous pump infusion.TOF(train of four)stimulation was used to record the time of muscle strength recovery at 25%(T25),50%(T50),75%(T75)and 90%(T90).Moreover the restlessness scores(PAED)were recorded at Tp0,5 min(Tp5),10 min(Tp10),25 min(Tp25)and 40 min(Tp40).Results As compared with that in NS group,the time at T25,T50,T75 and T90 in DH group was significantly prolonged(P<0.05),however,there was no significant difference in the time at T25,T50,T75 and T90 between DL group and DM group(P>0.05).As compared with those in NS group,the incidence rates of PAED scores>15 points at Tp0,Tp5,Tp10 and Tp25 in DH group and DM group were significantly decreased(P<0.05),however,there were no significant differences at Tp40(P>0.05),moreover,there were no significant differences in every time points in DL group(P>0.05).Conclusion Application of dexmedetomidine at 0.6μg/kg at stage of analepsia in children undergoing general anesthesia can lengthen the recovery time of muscle strength and can decrease the incidence rate of restlessness,and the application of dexmedetomidine at 0.4μg/kg has no obvious effects on recovery time of muscle strength and can decrease the incidence rate of restlessness,moreover,the application of dexmedetomidine at 0.2μg/kg has no obvious effects on both recovery time of muscle strength and incidence rate of restlessness.