右美托咪定复合全凭静脉麻醉或全凭吸入麻醉对OSAHS患儿血流动力学影响的比较

Comparison of the hemodynamic effects of a loading dose of dexmedetomidine combined with total intravenous anesthesia or inhalation anesthesia on children with obstructive sleep apnea-hypopnea syndrome

目的探讨全凭静脉麻醉和全凭吸入麻醉维持期间,应用负荷剂量右美托咪定(dexmedetomidine, Dex)对阻塞性睡眠低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)手术患儿血流动力学的影响。方法全身麻醉下行扁桃体和/或腺样体切除术的患儿50例,按随机数字表法分为全凭静脉麻醉维持组(A组)和全凭吸入麻醉维持组(B组),每组25例。两组均在诱导后给予负荷剂量Dex(1 μg/kg,输注时间设定为10min)。观察两组患儿输注Dex前(T0)、输注Dex后5min(T5)、输注Dex后10min(T10)的SBP、DBP、MAP、心率。结果与T0时比较,A组患儿T5、T10时SBP、DBP和MAP升高(P<0.05),B组患儿T10时SBP、DBP、MAP降低(P<0.05),两组患儿T5、T10时心率均下降(P<0.05)。结论在麻醉维持期间,OSAHS手术患儿应用负荷剂量Dex配伍全凭静脉麻醉药可升高动脉血压,而配伍全凭吸入麻醉药可降低动脉血压。

Objective To investigate the effects of a loading dose of dexmedetomidine(Dex) on the hemodynamics of children with obstructive sleep apnea-hypopnea syndrome(OSAHS) during total intravenous anesthesia and total inhalation anesthesia. Methods A total of 50 patients scheduled for adenotonsillectomy were enrolled in the study, and randomly divided into a total intravenous anesthesia group (group A) and an inhaled anesthesia group (group B)(n=25). After anesthesia induction, both groups were given a loading dose of Dex (1 μg/kg over 10 min). The systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP) and heart rate were recorded before infusion(T0), 5 min(T5) and 10 min(T10) after administration of Dex. Results Compared with baseline values, group A presented remarkable increases in SBP, DBP and MAP at T5 and T10(P<0.05). Group B demonstrated decreased SBP, DBP and MAP 10 min after infusion(P<0.05). The heart rate in the both groups were significantly decreased after Dex infusion(P<0.05). Conclusions During anesthesia maintenance, a loading dose of Dex can significantly increase arterial blood pressure in OSAHS patients when combined with total intravenous anesthesia, and significantly decrease arterial blood pressure when combined with inhaled anesthesia.