右美托咪定滴鼻对腹腔镜腹股沟斜疝手术患儿顺苯磺酸阿曲库铵肌松效应的影响

Effects of intranasal dexmedetomidine on atracurium muscle relaxation in children undergoing laparoscopic indirect inguinal hernia surgery

目的探讨右美托咪定滴鼻对腹腔镜腹股沟斜疝手术患儿顺苯磺酸阿曲库铵肌松效应的影响。方法择期腹腔镜腹股沟斜疝疝囊高位结扎的患儿40例,年龄2~7岁,采用随机对照表法分为右美托咪定组(D组)和0.9%氯化钠溶液组(C组),每组20例。入手术室等候区后,D组给予2μg/kg右美托咪定滴鼻,C组给予等量0.9%氯化钠溶液滴鼻。入手术室后连续监测患儿平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS)及血氧饱和度(SpO 2),采用咪达唑仑-芬太尼-顺苯磺酸阿曲库铵诱导气管插管,术中采用丙泊酚-瑞芬太尼维持麻醉。患儿入睡后开启TOF-WatchSX加速度仪监测神经肌肉功能。于顺苯磺酸阿曲库铵给药前、给药后15 min和30 min、气管插管前后时记录HR和SpO 2。给药后30 min记录患儿镇静评分、与父母分离时情绪评分、面罩吸入诱导抵抗评分、顺苯磺酸阿曲库铵起效时间、临床作用时间及恢复指数。结果与C组比较,D组镇静评分、与父母分离时的情绪评分、面罩吸入诱导抵抗评分升高,HR降低(P<0.05),SpO 2、顺苯磺酸阿曲库铵起效时间、临床作用时间、恢复指数比较差异无统计学意义(P>0.05)。结论对于腹腔镜腹股沟斜疝手术小儿,右美托咪定术前滴鼻并未延长顺苯磺酸阿曲库铵的起效时间及维持时间,但可降低患儿焦虑恐惧情绪,还可以抑制插管反应,稳定血流动力学。

Objective To investigate the effects of intranasal dexmedetomidine on atracurium muscle relaxation in children undergoing laparoscopic indirect inguinal hernia surgery.Methods A total of 40 children aged 2 to 7 years who underwent laparoscopic high ligation of the inguinal oblique hernia sac were randomly divided into two groups:dexmedetomidine group(group D)and normal saline group(group C),with 20 cases in each group.After entering the waiting area of the operating room,the patients in group D was given dexmedetomidine 2μg/kg intranasally,however,the patients in group C were given the same amount of normal saline intranasally.Midazolam-fentanyl-cisatracurium was used to induce endotracheal intubation,and propofol-remifentanil was used to maintain anesthesia effects.The TOF-WatchSX accelerometer was turned on to monitor muscle relaxation after the children fell asleep.The heart rate and pulse oxygen saturation were recorded before intranasal administration and at 15min,30min after intranasal administration,before and after trachea cannula.Moreover the sedation scores,emotional scores at the time in patients separating from their parents,mask inhalation induced resistance scores,onset time of cisatracurium,clinical response time and recovery indexes were recorded at 30min after intranasal administration.Results As compared with those in group C,the sedation scores and emotion scores at the time in patients separating from their parents,mask inhalation induced resistance scores in group D were significantly increased,but heart rate was significantly decreased(P<0.05).There were no significant differences in SpO 2,cisatracuronium onset time,clinical effect time and recovery indexes between the two groups(P>0.05).Conclusion For children undergoing laparoscopic indirect inguinal hernia surgery,intranasal dexmedetomidine can not extend the onset time and maintenance time of atracurium besilate,however,which can reduce anxiety and fear emotion of children patients,inhibit intubation reaction and stabilize hemodynamics.