不同剂量舒芬太尼联合右美托咪定对全麻下行腹腔镜阑尾手术患儿血流动力学及脑电双频指数变化的影响

Effects of Different Doses of Sufentanil Combined with Dexmedetomidine on Hemodynamics and Bispectral Index in Children Undergoing Laparoscopic Appendectomy under General Anesthesia

目的:探索不同剂量舒芬太尼联合右美托咪定对全麻下行腹腔镜阑尾手术患儿血流动力学及脑电双频指数(BIS)变化的影响。方法:选取2017年4月-2018年3月于本院确诊并收入院治疗的60例气管插管全麻下行腹腔镜阑尾手术的患儿为研究对象,按照随机数字表法将其分为低、中、高剂量组,每组20例,患儿在给予相同剂量右美托咪定的基础上,分别联合给予0.2、0.3、0.4μg/kg剂量的舒芬太尼。记录患儿入室即刻(T0)、麻醉诱导后(T1)、气管插管即刻(T2)、气管插管后15 min(T3)、术毕即刻(T4)五个时间点的心率(HR)、平均动脉压(MAP)和BIS,记录患儿经麻醉诱导期间出现的不良反应;术后观察并记录呼吸恢复时间、拔管时间、麻醉苏醒时间。结果:高剂量组T1、T2时MAP、HR在三组中最低(P<0.05),高剂量组T3、T4时HR在三组中最低(P<0.05),但三组T3、T4时MAP比较,差异无统计学意义(P>0.05);三组组内不同时刻的MAP、HR比较,差异均有统计学意义(P<0.05),其中中剂量组HR、MAP数值波动较为平缓。三组使用药物后BIS均显著下降,差异有统计学意义(P<0.05);三组各时间点BIS比较,高剂量组BIS低于中剂量组、低剂量组(P<0.05)。麻醉诱导期间三组不良反应发生率比较,差异均无统计学意义(P>0.05)。三组呼吸恢复时间、拔管时间、苏醒时间比较,差异均无统计学意义(P>0.05)。结论:0.3μg/kg的舒芬太尼对患儿血流动力学与BIS的影响相对不明显,且具有更好的安全性,因此使用该剂量进行小儿麻醉诱导更加合理,并值得临床推广应用。

Objective:To explore the effects of different doses of Sufentanil combined with Dexmedetomidine on hemodynamics and bispectral index(BIS)in children undergoing laparoscopic appendectomy under general anesthesia.Method:Sixty children who admitted to our hospital from April 2017 to March 2018 for laparoscopic appendectomy were randomly divided into low,medium and high dose groups.They were given 0.2,0.3 and 0.4μg/kg Sufentanil respectively base on the same dose of Dexmedetomidine.Heart rate(HR),mean arterial pressure(MAP)and BIS were measured at immediately after admission(T0),immediately after anesthesia induction(T1),immediately after tracheal intubation(T2),15 minutes after tracheal intubation(T3),and immediately after operation(T4).Adverse reactions during induction of anesthesia were recorded,and respiratory recovery time,extubation time and anesthesia recovery time were recorded after operation.Result:MAP and HR at T1 and T2 in high dose group were the lowest among the three groups(P<0.05),while HR at T3 and T4 in high dose group was the lowest among the three groups(P<0.05),but there was no significant difference in MAP at T3 and T4 among the three groups(P>0.05),there were significant differences in MAP and HR at different time among the three groups(P<0.05),the fluctuation of HR and MAP in the middle dose group was relatively gentle.The BIS of the three groups decreased significantly(P<0.05),the BIS of high dose group were lower than those of medium dose group and low dose group at each time point(P<0.05).The incidence of total adverse reactions during anesthesia induction was significantly different(P<0.05).There were no significant differences in the incidence of adverse reactions during anesthesia induction among three groups(P>0.05).There were no significant differences in respiratory recovery time,extubation time and recovery time among three groups(P>0.05).Conclusion:0.3μg/kg Sufentanil has relatively insignificant effect on hemodynamics and BIS in children,and has better safety.Therefore,it is more reasonable to use this dose to induce pediatric anesthesia,and it is worthy of clinical application.