右美托咪定对小儿七氟烷麻醉术后苏醒期躁动及血流动力学的影响

Effect of dexmedetomidine on agitation and hemodynamics during the recovery period in children after sevoflurane anesthesia

目的探讨右美托咪定对小儿七氟烷麻醉术后苏醒期躁动及血流动力学的影响。方法选取2019年1月至2020年12月绍兴市中心医院收治的扁桃体、腺样体择期切除术患儿120例,按随机数字表法分为对照组和观察组,每组60例。两组均行七氟烷吸入诱导,0.6 mg罗库溴安、2μg/kg芬太尼静脉推注后气管插管。观察组行右美托咪定复合七氟烷维持麻醉,对照组给予等量0.9%氯化钠复合七氟烷维持麻醉。比较两组麻醉前(T0)、气管插管时(T1)、手术开始时(T2)、手术结束时(T3)的心率(HR)、平均动脉压(MAP)水平,以及麻醉时间、手术时间、苏醒时间和拔管时间。比较两组麻醉后躁动量化评分(PAED)、面部表情量表法(FPS)评分以及躁动发生率、术后特殊事件发生率。结果两组手术时间、麻醉时间、拔管时间和苏醒时间比较差异无统计学意义(P>0.05)。对照组在T1、T2、T3时间点HR与MAP水平呈上升趋势,并且高于同时间点观察组,差异有统计学意义(P<0.05)。观察组FPS、PAED评分及躁动发生率均低于对照组[(2.32±0.61)分比(3.66±0.85)分、(6.88±1.85)分比(11.75±3.03)分、13.33%(8/60)比3.33%(2/60)],差异有统计学意义(t=9.92、10.63,χ^(2)=3.93,P<0.05)。观察组术后异丙酚处理、需止痛药处理及呼吸道相关不良事件发生率均低于对照组[3.33%(2/60)比13.33%(8/60)、5.00%(3/60)比16.67%(10/60)、3.33%(2/60)比15.00%(9/60)],差异有统计学意义(χ^(2)=3.93、4.23、4.90,P<0.05)。结论右美托咪定维持麻醉诱导对小儿七氟烷麻醉可有效降低患儿苏醒期躁动的发生率,且对其血流动力学影响较小,安全性较高。

Objective To investigate the effect of dexmedetomidine on agitation and hemodynamics during the recovery period in children after sevoflurane anesthesia.Methods A total of 120 pediatric patients with selective tonsillectomy and adenoidectomy admitted to Shaoxing Central Hospital from January 2019 to December 2020 were randomly divided into the control group and the observation group,with 60 cases in each group.Both groups were induced by sevoflurane inhalation,followed by endotracheal intubation with 0.6 mg rocuronium and 2μg/kg fentanyl intravenous injection.The observation group received dexmedetomidine combined with sevoflurane to maintain anesthesia,while the control group received normal saline combined with sevoflurane to maintain anesthesia.Heart rate(HR)and mean arterial pressure(MAP)were recorded at four times:before anesthesia(T0),endotracheal intubation(T1),the beginning of surgery(T2)and the end of surgery(T3).The time of anesthesia,surgery,recovery and extubation were recorded.Pediatric anesthesia emergence delirium(PAED)score,faces pain scale(FPS)score,the incidence of agitation and postoperative special events were compared between the two groups.Results There were no significant differences in operation time,anesthesia time,extubation time and recovery time between the two groups(P>0.05).The levels of HR and MAP in the control group were increased at T1,T2,T3,and were higher than those in the observation group,the differences were statistically significant(P<0.05).The scores of FPS,PAED and the incidence of agitation in the observation group were lower than those in the control group:(2.32±0.61)scores vs.(3.66±0.85)scores,(6.88±1.85)scores vs.(11.75±3.03)scores,13.33%(8/60)vs.3.33%(2/60),the differences were statistically significant(t=9.92,10.63,χ^(2)=3.93,P<0.05).The incidences of postoperative treatment with propofol,analgesics and respiratory tract adverse events in the observation group were lower than those in the control group:3.33%(2/60)vs.13.33%(8/60),5.00%(3/60)vs.16.67%(10/60),3.33%(2/60)vs.15.00%(9/60),the differences were statistically significant(χ^(2)=3.93,4.23,4.90,P<0.05).Conclusions Dexmedetomidine maintenance induction of anesthesia for sevoflurane anesthesia in children can effectively reduce the incidence of agitation in the period of recovery,and has little effect on hemodynamics,with high safety.