右美托咪定与咪达唑仑对小儿泌尿外科手术麻醉效果和血流动力学的影响比较

Comparison of effects of dexmedetomidine and midazolam on anesthesia and hemodynamics during pediatric urology surgery

目的探讨右美托咪定与咪达唑仑对小儿泌尿外科手术麻醉效果和血流动力学的影响比较。方法选取2013年9月—2016年9月期间西安市儿童医院确诊治疗的小儿泌尿外科手术患儿120例,依据随机数表法随机分为右美托咪定组(右美组)和咪达唑仑组(咪达组),每组60例,右美组患儿在全身麻醉诱导前给予0.5μg/kg的右美托咪定弹丸式静脉注射,持续10 min,全身麻醉诱导后给予持续微量泵注射0.5μg/(kg·h)的负荷量维持,咪达组患儿在全身麻醉诱导前给予0.03 mg/kg的咪达唑仑弹丸式静脉注射,持续10 min,全身麻醉诱导后给予持续微量泵注射0.05 mg/(kg·h)的负荷量维持,采用Ramsay镇静评分法(Ramsay)评估麻醉效果,采用儿童麻醉苏醒期躁动评分法(PAED)评估躁动的发生,统计分析所有患儿麻醉前(T0)、麻醉10 min时(T_1)、切皮时(T_2)、拔管时(T_3)、缝合时(T_4)的心率(HR)、平均动脉压(MAP)、氧气耗量(VO_2)、二氧化碳排出量(VCO_2)水平、镇静深度和镇静深度达标所需时间、围术期不良反应、苏醒时间等情况。结果右美组患儿T_1、T_2、T_3、T_4时刻的HR、MAP水平显著低于咪达组,差异有统计学意义(P<0.05);右美组患儿T_1、T_2、T_3、T_4时刻的Ramsay得分显著高于咪达组,前者镇静深度达标所需时间显著低于后者,差异有统计学意义(P<0.001);右美组患儿T_1、T_2、T_3、T_4时刻的VO_2、VCO_2水平显著低于咪达组,差异有统计学意义(P<0.001);右美组和咪达组患儿围术期不良反应发生率比较,差异无统计学意义(P>0.05),但右美组患儿苏醒期躁动发生率、苏醒时间低于咪达组,差异有统计学意义(P<0.05)。结论与咪达唑仑麻醉处理比较,右美托咪定可有效提高小儿泌尿外科手术患儿的麻醉效果,可有效维持患儿术中血流动力学的稳定和镇静深度,且可有效降低患儿术中的能量代谢和苏醒期躁动的发生,有利于减少手术操作所引起机体的应激反应和提高患儿苏醒质量,并具有良好的安全性,值得临床作进一步推广。

Objective To compare the effect of dexmedetomidine and midazolam on anesthesia and hemodynamics during pediatric urology surgery. Methods One hundred and twenty children who were scheduled for pediatric urology surgery between September 2013 and September 2016 in Xi'an Children's Hospital were selected. Using the random number table, all the patients were divided into the dexmedetomidine group and midazolam group, with 60 cases in each group. The dexmedetomidine group was given 0.5 μg/kg dexmedetomidine via intravenous bolus injection for 10 min before induction of general anesthesia. After induction of general anesthesia, a load of 0.5 μg(/kg·h) was used to maintain anesthesia via continuous micro pump injection. The midazolam group was given 0.03 mg/kg midazolam for 10 min via intravenous bolus injection before induction of general anesthesia. After induction of general anesthesia, continuous micro pump injection of 0.05 mg(/kg·h)was adopted for maintenance. The Ramsay sedation score method(Ramsay)was used to assess the effect of anesthesia, while PAED was used to assess the occurrence of emergency agitation. Heart rate(HR), mean arterial pressure(MAP), oxygen consumption(VO2), carbon dioxide discharge(VCO2), levels of sedation and the time taken to reach the standard depth of sedation, perioperative adverse reactions, and wake-up time were statistically analyzed at different time points. Results HR and MAP levels of the dexmedetomidine group were significantly lower than those of the midazolam group at four time points(P<0.05). Ramsay scores of the dexmedetomidine group were significantly higher than those of the midazolam group(P<0.001). VO2, VCO2 levels of the dexmedetomidine group were significantly lower than those of the midazolam group, and there was statistically significant difference(P<0.001).The perioperative incidence of adverse reactions of the two groups was basically the same, so there was no statistically significant difference(P>0.05), but the incidence of emergency agitation and wake-up time of the dexmedetomidine group were significantly lower or shorter than those of the midazolam group, so there was statistically significant difference(P <0.05). Conclusion Compared with anesthesia with midazolam, dexmedetomidine can effectively improve the anesthetic effect of children undergoing pediatric urology surgery, and maintain the intraoperative hemodynamic stability a nd de pth of sedation w hiling reducing e nergy m etabolism a nd e mergency a gitation.