右旋美托咪定对小儿七氟醚麻醉后苏醒期躁动的影响被引量：71

Effect of dexmedetomidine on emergence agitation in children after sevoflurane anesthesia undergoing tonsillectomy and adenoidectomy

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摘要目的评价右旋美托咪定对扁桃体剥离合并腺样体吸切手术患儿七氟醚麻醉后苏醒期躁动的影响。方法择期实施扁桃体剥离合并腺样体吸切手术的患儿60例,年龄2～7岁,体重15～30kg,ASAⅠ～Ⅱ级,随机分为右旋美托咪定组(D组)和生理盐水对照组(C组),两组患儿均为七氟醚吸入诱导,芬太尼2μg/kg,罗库溴铵0.6mg/kg静脉推注后气管插管。D组静脉内右旋美托咪定1μg/kg负荷并1μg.kg-1.h-1持续泵入,复合七氟醚维持麻醉;C组给予同等容积生理盐水复合七氟醚维持麻醉。两组患儿在扁桃体剥离前、后进行两次1%利多卡因局部浸润,术毕给予对乙酰氨基酚肛栓。术中根据心率、收缩压的变化(变化范围为基础值30%以内)调节七氟醚的吸入浓度。记录患儿手术时间、麻醉时间;术中心率(HR)、平均动脉血压(MAP)和MAC变化;术后苏醒时间(TA)、拔管时间(TE)。PACU期间,根据小儿麻醉苏醒期躁动量化评分表(pediatricanesthesia emergence delirium scale,PAED)进行躁动评估,面部表情量表法(faces pain scale-revised,FPS-R)进行疼痛评估;对比患儿呼吸道相关并发症、术后对止痛药物的需求。结果与对照组比较,右旋美托咪定组患儿苏醒期躁动明显减少[D组5/30(16%)、C组16/30(53%)],苏醒期躁动峰值显著降低(P<0.05);术后疼痛评分、术中七氟醚的MAC值、术后呼吸道相关并发症以及术后对止痛药的需求均降低(P<0.05)。结论小儿扁桃体剥离合并腺样体吸切手术中,应用右旋美托咪定可以减少七氟醚麻醉后苏醒期躁动。 Objective To evaluate the effect of dexmedetomidine on the emergence agitation in children undergoing tonsillectomy and adenoidectomy（T A）.Methods Sixty childrens undergoing elective tonsillectomy and adenoidectomy were randomly divided into two groups（group C and D） with thirty cases each.After mask induction with sevoflurane,group D received iv dexmedetomidine 1 μg/kg over 10 minutes,followed by 1 μg·kg-1·h-1,and group C received iv NS.Anesthesia was maintained with sevoflurane and oxygen.Paracetamol suppositories was given through rectual at the end of the surgery.Emergence agitation was evaluated by the pediatric anesthesia emergence delirium scale（PAED）.Pain was evaluated by face pain scale-revised（FPS-R）.Results The frequency of emergence agitation in the PACU was 16% in group D and 53% in group C.PAED peak,minimum alveolar concentration values,the median objective pain score,mean systolic blood pressure,heart rate,patients had an episode of SpO2 below 95%,patients required rescue fentanyl were all lower in group D compared with group C（P0.05）.Conclusions An intraoperativeinfusion of dexmedetomidine combined with sevoflurane provided satisfactory intraoperative conditions for T A without adverse hemodynamic effects.The incidence and duration of emergence agitation was lowered with dexmedetomidine.

作者贾继娥陈佳瑶李文献

机构地区复旦大学附属眼耳鼻喉科医院麻醉科

出处《复旦学报（医学版）》 CAS CSCD 北大核心 2012年第3期293-296,323,共5页 Fudan University Journal of Medical Sciences

关键词右旋美托咪定七氟醚儿童手术麻醉苏醒期躁动 dexmedetomidine sevoflurane children surgery and anesthesia emergence agitation

分类号 R971.2 [医药卫生—药品]

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