国际麻醉学与复苏杂志   2014, Issue (10): 11-11
    
地佐辛复合右美托咪定在小儿术中的临床应用
董静宇, 白武民, 石翊飒1()
1.兰州大学第二医院
Effect of dezocine combined with dexmedetomidine used in pediatric anesthesia
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摘要:

目的 观察地佐辛单独或复合右美托咪定(dexmedetomidine, Dex)应用于小儿手术围麻醉期的效果。 方法 选择60例美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级、年龄4岁~10岁、体重14 kg~40 kg、择期在全麻下行扁桃体、腺样体摘除术的患儿,采用随机数字表法分为对照组(C组)、多模式镇痛组(M组)、地佐辛组(D组),每组20例。M组以1 μg/kg负荷量泵注Dex 10 min,随后以0.5 μg·kg-1·h-1持续泵注,共计1 h;C组、D组泵注等体积生理盐水。3组麻醉诱导及维持方法相同。术毕前15 min,M组、D组静脉给予地佐辛0.1 mg/kg,C组给予等体积生理盐水。记录患儿入室时(T1)、泵注后5 min(T2)、插管后即刻(T3)、拔管后即刻 (T4)、拔管后5 min (T5)各时间点生命体征,麻醉、手术、苏醒、拔管时间,以及术后躁动、副作用情况。 结果 苏醒期躁动发生率、躁动评分M组(10%,2.0±0.7)、D组(30%,2.4±0.8),明显低于C组(65%,3.2±1.0)(P<0.05);术中维持用七氟醚用量M组(5.8±2.0) ml,明显低于C组(8.8±2.5) ml(P<0.05);M组T2~T5时点心率明显低于C组、D组(P<0.05);与C组比较,M组术后心动过速发生率较低(35% vs 0)(P<0.05)。3组患儿麻醉、手术、苏醒及拔管时间差异均无统计学意义(P>0.05)。 结论 术毕前15 min静脉注射地佐辛0.1 mg/kg可安全应用于小儿,能有效抑制术后躁动的发生;该剂量复合Dex还可减少术中麻醉维持药用量,使患儿在围麻醉期生命体征更平稳,可提高患儿术后恢复质量及家属满意度。

关键词: 地佐辛; 右美托咪定; 围麻醉期; 小儿
Abstract:

Objective To investigate the effect of dezocine alone or combined with dexmedetomidine(Dex) in pediatric anesthesia. Methods Sixty ASA Ⅰ-Ⅱ pediatric patients, aged 4 y-10 y, weighing 14 kg-40 kg, scheduled for tonsillectomy and adenoidectomy were randomly divided into three groups (n=20): the control group (group C), multimodal analgesia group (group M) and the dezocine group (group D). Patients in M group started with intravenous infusion of Dex(1 μg/kg) for 10 min. After 10 min, Dex(0.5 μg·kg-1·h-1) were continually given to patients for 1 h. Patients in group C and group D received the same volume of normal saline. Group M and group D received dezocine(0.1 mg/kg) 15 min before the end of surgery, group C received the same volume of normal saline. Three groups use the same induction and maintenance of anesthesia. Vital signs were compared among the three groups at 5 time points: patient entering the operation room(T1), 5 min after intravenous infusion(T2), intubation(T3), extubation(T4), 5 min after extubation(T5). The duration of anesthesia and surgery, duration for anesthesia recovery and extubation, postoperative agitation and adverse reaction were recorded as well. Results Compared with group C[65%,(3.2±1.0)], the incidence and the grading of agitation were lower in group M[10%, (2.0±0.7)] and group D[30%,(2.4±0.8)] in anesthesia recovery period(P<0.05). Compared with group C[(8.8±2.5) ml], the intraoperative sevoflurane requirement was significantly lower in the group M[(5.8±2.0) ml] during the maintenance of anesthesia(P<0.05). Compared with group C and group D, the heart rate was significantly lower in group M at T2?蛳T5(P<0.05). Compared with group C, the incidence of postoperative tachycardia were lower in group M(35% vs 0%)(P<0.05). The duration of anesthesia, duration of operation, anesthesia recovery period and extubation were not statistically different between three groups (P>0.05). Conclusions Injection of dezocine (0.1 mg/kg) at 15 min before the end of operation is safe for the pediatric patients and can effectively reduce postoperative agitation. This usage of dezocine combined with Dex grants advantages in pediatric multimodal analgesia. It has an analgesic-sparing effect, and maintains the patients' vital sign stable throughout the perioperative period. This approach improves the recovery quality and therefore the patients'/family's satisfaction.

Key words: Dezocine; Dexmedetomidine; Perianesthesia; Pediatric