右美托咪定辅助镇静对幼儿肛门脓肿术行骶管麻醉的影响

Effects of dexmedetomidineon assisted sedation in sacral anesthesia for children with anal abscess surgery

目的分析右美托咪定用于骶管麻醉辅助镇静在幼儿肛周脓肿一次性根治术中的效果。方法选取义乌復元私立医院2016年6月至2018年12月收治的78例择期行一次性肛周脓肿根治术患儿,均行骶管麻醉辅助镇静,将患儿随机分为对照组和观察组,两组各39例,对照组给予丙泊酚辅助镇静,观察组给予盐酸右美托咪定辅助镇静。比较两组患儿在不同时间点时平均动脉压、心率、脑电双频谱指数(BIS)和血清肾上腺素、皮质醇、空腹血糖的变化情况,并比较两组患儿术后躁动和呼吸抑制的发生情况及苏醒时间的差异。结果观察组在探查内口时(T3)及病灶切除时(T4)时平均动脉压和心率较对照组均明显下降(t值分别为1.37、2.88、4.77、3.28,均P<0.05),而两组患儿不同时间点的BIS值比较差异并无统计学意义(P>0.05)。观察组在切皮时(T2)、T3及T4时血清肾上腺素和皮质醇水平较对照组均明显下降(肾上腺素:t值分别为2.64、5.22、4.79;皮质醇:t值分别为1.65、13.11、15.38,均P<0.05),而两组患儿不同时间点的空腹血糖比较,差异并无统计学意义(P>0.05)。观察组术后苏醒时间[(12.79±3.58)min]较对照组[(19.96±4.17)min]明显缩短(t=8.15,P<0.01),且术后躁动(0 vs.17.95%)和呼吸抑制(0 vs.15.38%)发生率较对照组均明显下降(χ2值分别为5.65、4.51,均P<0.05)。结论盐酸右美托咪定在肛周脓肿一次性根治术患儿骶管麻醉辅助镇静过程中具有促进生命体征平稳,缓解机体应激反应,减少术后躁动和呼吸抑制的重要作用,因此值得临床应用。

Objective To analyze the effect of dexmedetomidine on assisted sedation in sacral anesthesia for children with one-off radical operation of perianal abscess. Methods Seventy-eight children with perianal abscess who underwent selective one-off radical operation in Yiwu Fuyuan Private Hospital from June 2016 to December 2018 were selected,all children underwent the assisted sedation sacral anesthesia and were randomly divided into control group and observation group,both with 39 cases. Propofol as adjuvant sedation in control group and observation dexmedetomidine hydrochloride as adjuvant sedation in observation group. The changes of mean arterial pressure,heart rate,bispectral index(BIS),serum adrenaline,cortisol and fasting blood glucose at different time points between the two groups were compared. The differences in occurrence of restlessness,respiratory depression and recovery time between the two groups were also compared. Results The mean arterial pressure and heart rate in the observation group were significantly decreased compared with control group when exploring the internal orifice(T3) and resecting the lesion(T4)(t=1.37,2.88,4.77 and 3.28,respectively,all P<0.05). There was no significant difference in the BIS values between the two groups at different time points(P>0.05). The levels of serum adrenaline and cortisol of observation group at the time of skin incision(T2),T3 and T4 were significantly decreased compared with control group(Adrenaline:t=2.64,5.22 and 4.79,respectively,all P<0.05. Cortisol:t=1.65,13.11 and 15.38,respectively,all P<0.05),but there was no significant difference in fasting blood glucose between the two groups at different time points(all P>0.05). The recovery time in the observation group [(12.79±3.58) min] was significantly shorter than that in the control group [(19.96±4.17) min](t=8.15,P<0.01),and the incidence of restlessness(0% vs.17.95%) and respiratory depression(0% vs.15.38%) were significantly lower than those in the control group(χ2=5.65 and 4.51,respectively,both P<0.05). Conclusion Dexmedetomidine hydrochloride plays an important role in promoting the stability of vital signs during the assisted sedation in sacral anesthesia for children with perianal abscess in one-off radical operation,that also alleviating stress response and reducing postoperative restlessness and respiratory depression. So,it is worthy of clinical application.