摘要
目的探讨行腹股沟斜疝修补术的患儿术中右美托咪定(DEX)辅助氯胺酮麻醉的适宜剂量。方法选取年龄为3~7岁、美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级、择期行腹股沟斜疝修补术的患儿100例,随机分为5组,每组20例。所有患儿均于入手术室后15min内静脉注射DEX负荷剂量1.0μg/kg、氯胺酮1mg/kg,持续静脉注射氯胺酮1mg·kg^(-1)·h^(-1)和不同剂量DEX维持麻醉。DEX0.4组、DEX0.6组、DEX 1.0组、DEX1.2组分别予静脉注射DEX 0.4、0.6、1.0和1.2μg·kg^(-1)·h^(-1),对照组予静脉注射0.9%氯化钠溶液5mL/h。若患儿发生体动,则追加芬太尼0.5~1.0μg/kg。手术结束前20min停止静脉注射DEX和氯胺酮。分别于麻醉前(T0)、DEX麻醉诱导后即刻(T1)、氯胺酮麻醉诱导后3min(T2)、手术开始(T3)、手术结束(T4)、术后睁眼(T5)各时间点,记录患儿的心率(HR)、平均动脉压(MAP)、脉博血氧饱合度(SpO2)、脑电双频指数(BIS)、Ramsay镇静评分,以及血浆皮质醇和血糖水平;于患儿离开手术室时记录其疼痛评分、芬太尼用量,以及麻醉苏醒和不良反应发生情况。结果在T4、T5时间点,DEX0.4组、DEX0.6组、DEX1.0组和DEX1.2组的血浆皮质醇和血糖水平均显著低于对照组同时间点(P值均<0.05),DEX1.0组和DEX1.2组的血浆皮质醇和血糖水平均显著低于DEX0.4组和DEX0.6组同时间点(P值均<0.05);DEX1.0组和DEX1.2组的HR均显著慢于对照组、DEX0.4组和DEX0.6组同时间点(P值均<0.05),Ramsay镇静评分均显著高于对照组、DEX0.4组和DEX0.6组同时间点(P值均<0.05)。各组各时间点间MAP、SpO2和BIS值的差异均无统计学意义(P值均>0.05)。DEX0.4组、DEX0.6组、DEX1.0组和DEX1.2组术中芬太尼用量和肢体扭动次数均显著少于对照组(P值均<0.05),DEX1.0组和DEX1.2组术中芬太尼用量和肢体扭动次数均显著少于DEX0.4组和DEX0.6组(P值均<0.05)。DEX1.0组、DEX1.2组患儿定向力恢复时间均显著长于对照组、DEX0.4组和DEX0.6组(P值均<0.05)。5组间患儿的睁眼时间、疼痛评分和不良反应情况的差异均无统计学意义(P值均>0.05)。结论行腹股沟疝修补术的患儿用DEX辅助氯胺酮麻醉时,以DEX 0.4~0.6μg·kg^(-1)·h^(-1)的剂量维持麻醉较合适。
Objective To explore the appropriate dose of dexmedetomidine （DEX） as an adjunct of ketamine anesthesia in children undergoing oblique inguinal hernia repair. Methods One hundred children, aged 3-7 years, American Society or Anesthesiologists （ASA） grade Ⅰ or Ⅱ, undergoing elective oblique inguinal hernia repair, were randomly divided into five groups （n = 20）. All the children received loading dose of DEX （1.0 μg/kg） infused within 15 rain and intravenous bolus ketamine （1 mg/kg）. Then, for the maintenance of anesthesia, ketamine was intravenously given at a rate of 1 mg · kg^-1 · h^-1 in all the children DEX was intravenously given at a rate of 0.4, 0.6, 1.0 and 1.2 μg · kg^- 1· h^-1 in the children of group D1, D2, D3 and D4, respectively, and normal saline （5 mL/h） was given in the children of group C as control. Additional fentanyl （0.5-1.0 μg/kg） was administered once body moving was found. DEX and ketamine infusion were stopped 20 rain before the end of surgery. Heart rate （HR）, mean arterial pressure （MAP）, saturation pulse oxygen （SpO2） bispectral index （BIS）, Ramsay sedation score, plasma cortisol and blood glucose were recorded at thefollowing time points., before anesthesia （T0）, immediately after induction with DEX （T1）, 3 min after induction with ketamine （T2）, the beginning of surgery （T3）, the end of surgery （T4） and after eye opening （T5）. The pain score and fentanyl consumption when the patients discharged from postanes thesia care unit as well as emergence agitation and adverse reaction also were recorded. Results At T4 and Ts, the levels of cortisol and blood sugar in group Dr, D2, D3 and D4 were significantly lower than those in group C （all P〈0.05） ; the levels of cortisol and blood sugar in group D3 and D4 were significantly lower than those in group D1 and D2 （all P〈0.05） ; the HR in group D3 and D4 were significantly lower than those in group D1, D2 and C （all P〈0.05） ; the Ramsay scores in group D3 and D4 were significantly higher than those in D1, D2 and C （all P〈0.05）. There were no significant differences in the MAP, SpO2 or BIS at any time point between groups （all P〉0.05）. The fentanyl consumption and the frequency of body moving in the group. D1, D2, D3 and D4 were significantly less than those in the group C （all P〈0.05）, and the above-mentioned parameters in the group D3 and D4 were significantly less than those in the group D1 and D2 （all P〈0.05）. The recovery time of orientation in the group D3 and D4 was significantly longer than those in the group D1, D2 and C （all P 〈0.05）. There were no significant differences in the time to eye opening, pain scores or adverse reaction between groups （all P〉0.05）. Conclusion Dexmedetomidine at a rate of 0.4 - 0.6 μg · kg^-1 · h^-1 is an appropriate dose as an adjunct of ketamine anesthesia for pediatric inguinal hernia repair.
出处
《上海医学》
CAS
CSCD
北大核心
2015年第8期625-628,共4页
Shanghai Medical Journal
基金
海南省卫生厅医学科研课题自筹资金资助项目(琼卫2013自筹-44)
关键词
腹股沟斜疝
右美托咪定
氯胺酮
儿童
Oblique inguinal hernia
Dexmedetomidine
Ketamine
Children
