右美托咪定滴鼻复合七氟醚面罩吸入全麻在小儿眼科短小手术中的应用

Application of dexmedetomidine nasal drops and sevoflurane mask inhalation general anesthesia in pediatric ophthalmic surgery

目的评价右美托咪定滴鼻复合七氟醚面罩吸入全麻在小儿眼科手术中的应用效果及安全性。方法随机选择择期行眼科短小手术的患儿60例,随机分为右美托咪定滴鼻复合七氟醚麻醉组(D组)和全凭面罩七氟醚吸入组(S组)。D组术前30min给予盐酸右美托咪定0.5ml(1μg/kg)一侧鼻腔滴鼻。S组则滴入0.5ml生理盐水。两组均采用潮气量法全凭吸入七氟醚麻醉诱导。记录患儿右美托咪定滴鼻前、诱导前、诱导后、手术结束时、苏醒时SPO2、HR、BP。记录两组诱导前或诱导时哭闹情况、诱导时间、手术时间、清醒时间及清醒后躁动情况。记录两组清醒后躁动发生率和持续时间,在患儿清醒后10min进行疼痛评分。结果 两组性别、年龄、体质量、ASA分级及手术时间比较,差异无统计学意义(均P>0.05)。D组SBP、DBP、HR在诱导前分别为(93±7)mmHg(1mmHg=0.133kPa)、(63±5)mmHg、(92±12)次/min,苏醒时分别为(93±6)mmHg、(64±5)mmHg、(103±16)次/min,均低于S组,差异有统计学意义(均P<0.05)。D组诱导时患儿哭闹9例,占30%,与S组比较显著减少。D组诱导时间为(39±7)s,与S组比较显著缩短。S组清醒后发生躁动6例(20%),D组2例(7%),D组躁动比例显著降低。S组术后疼痛评分(6.1±1.1)分,D组疼痛评分为(3.0±1.3)分,D组疼痛评分显著降低。结论 右美托咪定滴鼻复合七氟醚面罩吸入全麻在小儿眼科短小手术可降低诱导时患儿哭闹率,缩短诱导时间,减少苏醒时躁动发生率,减轻术后疼痛,是一种安全有效的麻醉方法。

Objective To evaluate the efficacy and safety of dexmedetomidine nasal drops combined with sevoflurane mask inhalation anesthesia in pediatric ophthalmic surgery. Methods Sixty children undergoing minor ophthalmic surgery were randomly divided into a dexmedetomidine nasal drops combined with sevoflurane anesthesia group (group D) and a face mask sevoflurane inhalation group (group S). Group D was given dexmedetomidine hydrochloride 0.5 ml (1 μg/kg) nasal drip 30 minutes before operation. In group S, 0.5 ml saline was dripped. Both groups were induced by sevoflurane inhaling anesthesia by tidal volume method. SPO2, HR, and BP were recorded before nasal drip, before induction, after induction, at the end of operation, and during recovery. The crying rates before or during induction, induction time, operation time, awakening time, and restlessness after awakening were recorded. The incidence and duration of restlessness after awakening were recorded. The pain scores were scored 10 minutes after awakening. Results There were no statistical differences in gender, age, weight, ASA grade, and operation time between the two groups (all P>0.05). The SBP, DBP, and HR were (93±7) mmHg (1 mmHg=0.133 kPa),(63±5) mmHg, and (92±12) beats/min before induction and were (93±6) mmHg,(64±5) mmHg,(103±16) beats/min when they were awake in group D, which were lower than those in group S (all P < 0.05). 9 children (30%) cried in group D, fewer than group S. The induction time was (39±7) s in group D, which was significantly shorter than that in group S. 6 cases (20%) were restless in group S and 2 (7%) in group D after awakening. The pain score was (6.1±1.1) in group S, and (3.0±1.3) in group D. Conclusion Dextrometridine nasal drops combined with sevoflurane mask inhalation general anesthesia is a safe and effective anesthesia method for children undergoing minor ophthalmic surgery, and can reduce crying rate, induction time, restlessness rate and pain after recovery.