国际麻醉学与复苏杂志   2013, Issue (11): 1-1
    
右旋美托咪定持续输注对小儿全麻术后躁动的影响
沈婷, 王英伟1()
1.上海市新华医院
The influence of persistent infusion of dexmedetomidine on pediatric postoperative emergence agitation.
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摘要:

目的:本文旨在探讨在小儿全麻手术中使用右美托咪定持续输注对术后躁动的影响。方法:选取ASA I~II级、72名4~10岁在全麻下行骨折切开复位内固定手术的患儿,随机分为四组,分别采用丙泊酚复合右旋美托咪定(0.5μg·kg-1·h-1)(PD组)及七氟醚复合右旋美托咪定(SD组),丙泊酚复合生理盐水(PN组)及七氟醚复合生理盐水(SN组)。分别记录患儿泵注右旋美托咪定前、泵注后10分钟、20分钟、30分钟及拔管时的心率、平均压、脑电双频指数;测定停止麻醉药物至拔管时间、睁眼时间;对术后患儿躁动及疼痛程度进行评分;计算患儿苏醒期躁动的发生率。结果:(1)PD组与PN组相比、SD组与SN组相比,拔管时间(7.1±2.6vs4.4±2.1分钟、7.3±2.1vs4.9±2.0分钟)及睁眼时间(16.3±5.7vs9.8±3.1分钟、13.4±5.8vs8.8±5.0分钟)显著延长(P<0.05),但PD组与SD组无显著差异(P>0.05)。(2)PD组与PN组、SD组与SN组相比较,术后躁动评分(1vs2分、3vs4分)及CHIPPS评分(2.5vs3分、4vs7分)下降(P<0.01)。SD组术后躁动发生率显著下降(SD组5.6%vs SN组33.3%)(P<0.05)。PD组的躁动评分低于SD组(P<0.05)。结论:右旋美托咪定虽会造成术后苏醒时间延长,但可以降低小儿麻醉术后躁动评分及术后即刻疼痛评分,并且显著降低七氟醚麻醉术后躁动发生率,使患儿苏醒期更加平稳。

关键词: 右旋美托咪定,苏醒期躁动,小儿全身麻醉
Abstract:

Objective: We are going to study the influence of persistent infusion of dexmedetomidine on pediatric postoperative emergence agitation. Methods:72 ASA I~II`patients aged 4-10 years old , scheduled for fractures open reduction and internal fixation surgery under general anesthesia were randomly allocated to four groups. Patients in group PD received propofol and dexmedetomidine(0.5μg·kg-1·h-1),while patients in group PN received propofol and sodium chloride. Patients in group SD received sevoflurane and dexmedetomidine, while patients in group SN received sevoflurane and sodium chloride. HR、MAP、BIS were recorded before drug delivery (T1 ),10 minutes (T2 )、20 minutes (T3)、30 minutes(T4) after administration and after extubation(T5). Time from stopping narcotic drugs to extubation (T6 ) and opening eyes(T7 ) were determinated. The score of postoperative degree of agitation and pain was measured. The incidence rate of agitation in recovery period was also caculated. (agitation score greater than 3). Results:(1) The extubation time (7.1±2.6vs4.4±2.1min、7.3±2.1vs4.9±2.0min)and opening eyes time (16.3±5.7vs9.8±3.1min、13.4±5.8vs8.8±5.0min)were both prolonged significantly when group PD compared with group PN and group SD compared with group SN(P<0.05).There is little statistical difference between group PD and group SD(P>0.05).(2) The postoperative agitation score (1vs2、3vs4) and pain score (CHIPPS, 2.5vs3、4vs7) were also decreased in group PD and group SD compared with group PN and group SD respectively(P<0.01).The incidence rate of postoperative agitation was decreased significantly in group SD (group SD 5.6%VS group SN 33.3%)(P<0.05). The emergence agitation score of group PD was lower than of group SD(P<0.05). Conclusions:Although dexmedetomidine may prolong the palinesthesia, it can decrease the postoperative agitation score and the pain score. The postoperative agition incidence rate is also reduced significantly. The patients may feel more comfortable.

Key words: dexmedetomidine , palinesthesia agitation, pediatric general anesthesia