不同剂量右美托咪定复合芬太尼在小儿腹腔镜疝修补术中的应用效果观察

Effects of Different Doses of Dexmedetomidine Combined with Fentanyl in Laparoscopic Hernia Surgery in Children

目的:探讨小儿腹腔镜疝修补术中采用不同剂量右美托咪定复合芬太尼麻醉的应用效果。方法:选取2021年5月~2022年5月在本院实施腹腔镜疝修补术治疗的患儿共128例,按随机数字表法分成高剂量组、中剂量组、低剂量组和对照组各32例,对照组给予0.1 mL·kg^(-1)·h^(-1)生理盐水,低、中、高剂量组给予0.1、0.5、0.7μg·kg^(-1)·h^(-1)右美托咪定,比较四组手术情况、镇痛效果、血流动力学及不良反应。结果:四组手术时间、拔管时间、苏醒时间、麻醉苏醒室停留时间比较差异无统计学意义(P>0.05),在丙泊酚、芬太尼用量及术后6、12、24 h疼痛评分上,高剂量组<中剂量组<低剂量组<对照组(P<0.05);四组T0、T1、T2、T3时刻平均动脉压(MAP)、心率(HR)比较差异无统计学意义(P>0.05),T2时刻HR、MAP较T0时刻降低(P<0.05),T1时刻MAP降低(P<0.05);四组不良反应发生率差异亦无统计学意义(P>0.05)。结论:小儿腹腔镜疝修补术中采用高剂量(0.7μg·kg^(-1)·h^(-1))右美托咪定复合芬太尼麻醉的应用效果较好,对患儿手术情况影响小,可有效提高镇痛效果,对血流动力学的影响较小,且术后不良反应较少。

Objective:To explore the effects of different doses of dexmedetomidine combined with fentanyl anesthesia in laparoscopic hernia surgery in children.Methods:A total of 128 children from May 2021 to May 2022 who underwent laparoscopic hernia surgery in our hospital were selected,and were divided into high-dose group,medium-dose group,low-dose group and control group by a random number table method,32 cases per group.The patients in the control group were anesthetized with 0.1 mL·kg^(-1)·h^(-1) saline combined with fentanyl,and those in the low-,medium-and high-dose groups were given 0.1,0.5 and 0.7μg·kg^(-1)·h^(-1) dexmedetomidine with fentanyl,respectively.The operation,analgesic effects,hemodynamics and adverse reactions were compared.Results:There was no significant difference among the four groups in terms of operation time,extubation time,awakening time and PACU stay time(P>0.05).In terms of propofol and fentanyl dosage,and pain scores at 6,12 and 24 h,high-dose group<medium-dose group<low-dose group<control group(P<0.05).There was no significant difference in mean arterial pressure(MAP)and heart rate(HR)at T0,T1,T2 and T3 among the four groups(P>0.05),while HR and MAP at T2 were lower than those at T0(P<0.05),and MAP at T1 were lower than those at T0(P<0.05).There was no significant difference in the incidence of adverse reactions among the four groups(P>0.05).Conclusion:The anesthesicala effects of high dose dexmedetomidine(0.7μg·kg^(-1)·h^(-1))combined with fentanyl for laparoscopic hernia surgery in children are good,which will not affect the operation of children.It can effectively improve the analgesic effects,will not affect the hemodynamics of children,and will not increase the postoperative adverse reactions.