右美托咪定对腹腔镜疝修补术患儿血流动力学、苏醒质量及术后镇痛的影响

Effects of dexmedetomidine on hemodynamics,quality of recovery from anesthesia and postoperative analgesia in children patients with hernia subjected to laparoscopic hernia repair

目的观察右美托咪定对腹腔镜疝修补术患儿血流动力学、苏醒质量及术后镇痛的影响。方法选取绍兴市上虞妇幼保健院2019年3月至2020年3月行腹腔镜疝修补术患儿120例为观察对象,采用随机数字表法分为观察组与对照组,每组60例。对照组患儿给予七氟烷吸入麻醉维持,观察组患儿给予盐酸右美托咪定静脉泵入维持。比较两组不同时点[切皮前5 min(T0)、切皮后5 min(T1)和切皮后15 min(T2)]血流动力学变化;比较两组患儿术后拔管时间、苏醒时间和清醒时间、躁动发生情况和躁动持续时间;比较术后3 h、12 h和24 h患儿疼痛视觉模拟评分法(VAS)评分情况。结果观察组T1时点平均动脉压(MAP)[(72.01±1.64)mmHg]和心率(HR)[(136.42±3.20)次/min]均低于对照组[(76.31±1.89)mmHg和(143.21±3.45)次/min(t=13.311、11.177,均P<0.05)];观察组T2时点MAP[(69.32±1.36)mmHg]和HR[(130.02±2.61)次/min]均低于对照组[(72.02±1.86)mmHg和(134.09±3.26)次/min(t=9.077、7.549,均P<0.05)];观察组患儿术后拔管时间[(7.15±0.89)min]、苏醒时间[(10.36±1.74)min]和清醒时间[(26.76±8.32)min],均短于对照组[(9.20±1.43)min、(8.23±1.56)min和(39.42±12.15)min(t=9.428、7.060、6.659,均P<0.05)];观察组躁动发生率[10.00%(6/15)]低于对照组[25.00%(15/60)](χ^(2)=4.675,P<0.05);观察组躁动持续时间[(6.75±1.32)min],短于对照组[(10.85±2.14)min(t=12.631,P<0.05)];观察组VAS评分[术后3 h:(2.15±0.34)分、术后12 h:(1.45±0.38)分,术后24 h:(1.08±0.26)分]分别低于对照组的(3.24±0.53)分、(2.16±0.39)分和(1.54±0.32)分(t=13.409、10.100、8.642,均P<0.05)。结论右美托咪定对腹腔镜疝修补术患儿术中血流动力学影响小,患儿苏醒快,躁动发生率低,且术后镇痛效果好。

Objective To investigate the effects of dexmedetomidine on hemodynamics,quality of recovery from anesthesia and postoperative analgesia in children patients with hernia subjected to laparoscopic hernia repair.Methods A total of 120 children patients who received laparoscopic hernia repair in Shangyu Maternal and Child Health Hospital from March 2019 to March 2020 were included in this study.They were randomly assigned to receive anesthesia maintenance with either inhaled sevoflurane(control group,n=60)or intravenous dexmedetomidine hydrochloride(observation group,n=60).The hemodynamic changes at different time points[5 minutes before skin incision(T0),5 minutes after skin incision(T1)and 15 minutes after skin incision(T2)]were compared between the control and observation groups.Time to extubation,time to recovery from anesthesia,time to wake up,occurrence of agitation,and duration of agitation were compared between the two groups.Visual Analogue Scale score at 3,12 and 24 hours after surgery were compared between the control and observation groups.Results Mean arterial pressure and heart rate measured at T1 in the observation group were(72.01±1.64)mmHg and(136.42±3.20)beats/minute,respectively,which were significantly lower than those in the control group[(76.31±1.89)mmHg and(143.21±3.45)beats/minute,t=13.311,11.177,both P<0.05].Mean arterial pressure and heart rate measured at T2 in the observation group were(69.32±1.36)mmHg and(130.02±2.61)beats/minute,respectively,which were significantly lower than those in the control group[(72.02±1.86)mmHg,(134.09±3.26)beats/minute,t=9.077,7.549,both P<0.05].Time to extubation,time to recovery from anesthesia,and time to wake up in the observation group were(7.15±0.89)minutes,(10.36±1.74)minutes,(26.76±8.32)minutes,respectively,which were significantly shorter than those in the control group[(9.20±1.43)minutes,(8.23±1.56)minutes,(39.42±12.15)minutes,t=9.428,7.060,6.659,P<0.05].The incidence of agitation in the observation group was significantly lower than that in the control group[10.00%(6/15)vs.25.00%(15/60),χ^(2)=4.675,P<0.05)].Duration of agitation in the observation group was significantly shorter than that in the control group[(6.75±1.32)minutes vs.(10.85±2.14)minutes,t=12.631,P<0.05].At 3,12 and 24 hours after surgery,Visual Analogue Scale score in the observation group was(2.15±0.34)points,(1.45±0.38)points and(1.08±0.26)points,respectively,which were significantly lower than that in the control group[(3.24±0.53)points,(2.16±0.39)points,(1.54±0.32)points,t=13.409,10.100,8.642,all P<0.05].Conclusion Dexmedetomidine hydrochloride has little effect on hemodynamics during surgery in children patients with hernia subjected to laparoscopic hernia repair,with fast recovery from anesthesia,a low incidence of agitation,and obvious postoperative analgesia.