小剂量右旋美托咪定在睡眠呼吸暂停综合征手术患儿七氟醚全麻苏醒期的作用分析

Role analysis of low dose Dexmetomide in the awakening period of Sevoflurane general anesthesia in children with sleep apnea syndrome surgery

目的探讨分析小剂量右旋美托咪定在睡眠呼吸暂停综合征手术患儿七氟醚全麻苏醒期的作用。方法选取2017年11月~2018年11月于我院接受手术治疗的66例睡眠呼吸暂停综合征患儿作为研究对象,所有患儿在七氟醚吸入全麻下采用扁桃体腺样体切除术进行治疗。采用随机数字表法将其分成观察组和参照组,每组各33例。参照组患儿在麻醉诱导前静注林格液,观察组患儿则予以静注小剂量右旋美托咪定。比较两组患儿在麻醉不同时期的心率(HR)、平均动脉压(MAP)变化情况,评定两组患儿全麻苏醒期的Ramsay镇静评分及苏醒期躁动量表(PAED)评分,并记录两组的躁动发生率、躁动持续时间以及麻醉苏醒时间。结果观察组患儿注射后10 min(T2)、清醒拔管时(T3)、拔管后5 min(T4)时的HR、MAP均低于参照组,差异有统计学意义(P<0.05)。观察组患儿的PAED评分、躁动发生率均低于参照组,Ramsay镇静评分高于参照组,躁动持续时间短于参照组,差异有统计学意义(P<0.05);两组患儿的麻醉苏醒时间比较,差异无统计学意义(P>0.05)。结论睡眠呼吸暂停综合征患儿在七氟醚全麻手术中应用小剂量右旋美托咪定,能保持更好的镇静效应,维持血流动力学平稳,降低苏醒期躁动的发生率,具有临床推广的价值。

Objective To investigate the role of low dose Dexmetomide in the awakening period of Sevoflurane general anesthesia in children with sleep apnea syndrome surgery. Methods A total of 66 children with sleep apnea syndrome who underwent surgical treatment in our hospital from November 2017 to November 2018 were selected as the research subjects. All children were treated with tonsil adenoidectomy under Sevoflurane inhalation general anesthesia. They were divided into observation group and reference group according to the random number table method, with 33 cases in each group. Children in the reference group were intravenously injected with Ringer′s solution before induction of anesthesia, and children in the observation group were given low dose Dexmedetomidine. The changes of heart rate(HR) and mean arterial pressure(MAP) of the two groups in different periods of anesthesia were compared. The Ramsay sedation score and pediatric anesthesia emergence delirium scale(PAED) score were evaluated, and the incidence of restlessness, the duration of restlessness and the awakening time of anesthesia were recorded in both groups. Results The HR and MAP in the observation group at 10 minutes after injection(T2), awake extubation(T3), and 5 minutes after extubation(T4) were lower than those in the reference group, and the differences were statistically significant(P<0.05).The PAED score and the incidence rate of restlessness in the observation group were lower than those in the reference group, the Ramsay sedation score was higher than that in the reference group, and the duration of restlessness was shorter than that in the reference group, the differences were statistically significant(P<0.05). There was no significant difference in the awakening time of anesthesia between the two groups of children(P>0.05). Conclusion The application of low dose Dexmetomide in children with sleep apnea syndrome during Sevoflurane general anesthesia can maintain better sedation effect, maintain hemodynamic stability, reduce the incidence rate of restlessness during recovery,and has the value of clinical promotion.