婴幼儿唇腭裂修补全麻术后运用右旋美托咪定预防患儿苏醒期躁动的效果研究

Study on the effect of dexmedetomidine on prevention of restlessness during recovery period of infants after general anesthesia for cleft lip and palate repair

目的研究探讨婴幼儿唇腭裂修补全麻术后,运用右旋美托咪定预防患儿苏醒期躁动的效果。方法选取我院2017年12月到2019年12月收治的婴幼儿唇腭裂患者共60例,按照随机数字表法随机分为研究组(30例)和对照组(30例),患儿经常规全身麻醉诱导后均给予七氟醚吸入维持,对照组患儿给予1μg/(kg·h)的生理盐水持续泵入维持,研究组患儿给予同等容积的右美托咪定泵入维持。比较两组患儿的血流动力学指标、血气分析指标以及麻醉苏醒期躁动指标。结果两组患儿在T0、T1以及T2阶段的心率(heart rate,HR)和平均动脉压(mean arterial pressure,MAP)差异无统计学意义(P>0.05)。研究组患儿在T3、T4以及T5阶段的HR和MAP明显低于对照组,差异具有统计学意义(P<0.05)。研究组患儿T5阶段的血气分析pH值显著低于对照组,对照组患儿T5阶段的pH值显著高于T0阶段,差异具有统计学意义(P<0.05),研究组患儿T5阶段pH值与T0阶段比较差异无统计学意义(P>0.05)。研究组患儿T5阶段PaCO;显著高于对照组,差异具有统计学意义(P<0.05),两组患儿T5阶段与T0阶段比较差异无统计学意义(P>0.05)。研究组患儿躁动评分、缝合口出血发生率及疼痛评分均显著低于对照组,差异具有统计学意义(P<0.05)。两组患儿自停止给予七氟醚吸入直至睁眼达到拔管指征的时间比较差异无统计学意义(P>0.05)。结论右旋美托咪定可显著减轻婴幼儿唇腭裂修补全麻术后苏醒期躁动的发生风险,可稳定血流动力学,有利于麻醉管理。

Objective To study the effect of dexmedetomidine on preventing restlessness during awakening after general anesthesia for cleft lip and palate repair in infants.Methods Sixty infants with cleft lip and palate admitted to our hospital from December 2017 to December 2019 were randomly divided into study group(30 cases)and control group(30 cases)according to a random number table method.The children were all given sevoflurane inhalation maintenance after induction of conventional anesthesia.Then the control group was given 1μg/(kg·h)of normal saline for continuous pumping maintenance,while the study group was given dexmedetomidine of the same volume for pumping maintenance.The hemodynamic indexes,blood gas analysis indexes and agitation indexes of these two groups were compared.Results There was no significant difference in HR and MAP between the two groups at T0,T1 and T2 stages(P>0.05).HR and MAP of the study group at T3,T4 and T5 stages were significantly lower than those of the control group(P<0.05).The pH value of the study group in T5 phase was significantly lower than that of the control group.The pH value in T5 phase of the control group was significantly higher than that in T0 phase(P<0.05),while the pH value in T5 phase of the study group was not significantly different from that in T0 phase(P>0.05).PaCO;of the study group at T5 stage was significantly higher than that of the control group(P<0.05),while there was no statistically significant difference in both groups at T5 stage and T0 stage(P>0.05).The agitation score,incidence rate of suture hemorrhage and pain score in the study group were significantly lower than those in the control group(P<0.05).There was no significant difference during the period between two compared groups of children from stopping inhaling sevoflurane to reaching the extubation indication with opening eyes(P>0.05).Conclusion Dexmedetomidine can significantly reduce the risk of restlessness in recovery period after general anesthesia for cleft lip and palate repair in infants and simultaneously stabilize hemodynamics,which is beneficial to anesthesia management.