右美托咪定对小儿七氟醚全身麻醉苏醒期躁动的影响

Effect of dexmedetomidine on restlessness during recovery period in child sevoflurane general anesthesia

目的探讨右美托咪定对小儿七氟醚全身麻醉苏醒期躁动的影响。方法选取在该院择期行手术治疗的110例患儿,分为对照组和观察组,每组55例。两组患儿均采用七氟醚全身麻醉,观察组患儿术中静脉给予右美托咪定1μg/kg负荷量,随后以1μg·kg^-1·h^-1持续泵入,对照组术中静脉注射等剂量0.9%生理盐水。记录两组患儿入室时(T0)、麻醉诱导即刻(T1)、气管插管时(T2)、术毕(T3)、拔管后(T4)平均动脉压(MAP)和心率(HR),并比较两组患儿围术期血流动力学、应激反应、炎症因子水平、苏醒时间及苏醒期躁动发生率等指标。结果观察组T2、T3、T4 MAP、HR值明显低于T0、T1(P<0.05);对照组T2、T3、T4 MAP、HR值明显高于T0、T1(P<0.05);观察组T2、T3、T4 MAP、HR值明显低于对照组T2、T3、T4(P<0.05);对照组T2、T4血清肾上腺素(E)、去甲肾上腺素(NE)水平与T0比较明显升高(P<0.05);观察组T2、T4血浆E、NE水平明显低于对照组(P<0.05);两组患儿T2、T4、T5、T6、T7肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素(IL)-6水平明显高于T0(P<0.05);观察组T2、T4、T5、T6、T7 TNF-α、CRP、IL-6水平显著低于同时间点对照组(P<0.05);两组患儿苏醒时间、拔管时间比较,差异无统计学意义(P>0.05);两组患者苏醒期躁动发生率、苏醒期躁动严重程度、术后简易智力状态量表(MMSE)评分、不良反应发生率比较,差异有统计学意义(P<0.05)。结论右美托咪定对小儿七氟醚全身麻醉苏醒期躁动的发生具有抑制和控制作用,且安全性较高。

Objective To investigate the effect of dexmedetomidine on restlessness during the recovery period in child sevoflurane general anesthesia.Methods A total of 110 children patients with elective operation in this hospital were selected and divided into the control group and observation group,55 cases in each group.The two groups adopted the sevoflurane general anesthesia.The children patients in the observation group were intravenously given 1μg/kg dexmedetomidine load dose,then pumped continuously with 1μg·kg^-1·h^-1.The patients in the control group were intravenously given the same dose of 0.9%normal saline.The mean arterial pressure(MAP)and heart rate(HR)were recorded at the time of admission(T0),instantly after anesthesia induction(T1),at the time of tracheal intubation(T2),at the end of operation(T3)and after extubation(T4).The hemodynamics,stress response,serum inflammatory factors levels,recovery time and incidence rate of agitation during recovery period were compared between the two groups.Results The values of MAP and HR at T2,T3 and T4 in the observation group were significantly lower than those at T0 and T1(P<0.05);the values of MAP and HR at T2,T3 and T4 in the control group were significantly higher than those at T0 and T1(P<0.05);the values of MAP and HR at T2,T3 and T4 in the observation group were significantly lower than those at T2,T3 and T4 in the control group(P<0.05);the levels of serum E and NE at T2 and T4 in the control group were significantly higher than those at T0(P<0.05);the levels of serum E and NE at T2 and T4 in the observation group were significantly lower than those in the control group(P<0.05).The levels of serum TNF-α,CRP and IL-6 at T2,T4,T5 and T7 in the two groups were significantly higher thanthose at T0(P<0.05);the levels of serum TNF-α,CRP and IL-6 at T2,T4,T5,T6 and T7 in the observation group were significantly lower than those at the same time points in the control group(P<0.05);the recovery time and extubation time had no statistical difference between the two groups(P>0.05);the incidence rate of restlessness,severity of restlessness,MMSE score and incidence rate of adverse reactions during recovery period had statistical differences between the two groups(P<0.05).Conclusion Dexmedetomidine has the inhibiting and control effect on the restlessness occurrence during the recovery period in child sevoflurane general anesthesia,moreover has high safety.