不同剂量右美托咪定干预七氟醚麻醉患儿苏醒期躁动的应用研究

Optimal dosage of three dexmedetomidine doses on prevention of agitation induced by sevoflurane anesthesia in children

关键词:  右美托咪定  七氟醚  苏醒期躁动  小儿麻醉

Key words:  [Key words]　dexmedetomidine  sevoflurane  awakening period of agitation  pediatric anesthesia

摘要:

[摘要]　目的　探讨麻醉诱导前静脉泵入不同剂量右美托咪定对七氟醚麻醉患儿苏醒期躁动的影响，并得出最佳使用剂量。　方法　纳入140例拟行下腹部手术的患儿，随机分为4组，每组35例，右美托咪定低剂量组（A组），右美托咪定中剂量组（B组），右美托咪定高剂量组（C组），生理盐水对照组（D组）。A组、B组、C组患儿于麻醉诱导前15 min内分别以0.4 μg/kg、0.7 μg/kg、1.0 μg/kg的剂量，静脉泵入右美托咪定，D组患儿以相同容量生理盐水静脉泵入。随后各组患儿采用潮气量法诱导，面罩和呼吸回路先预充8%七氟醚，扣面罩，自由呼吸或者深呼吸，入睡后行气管插管。麻醉机压力模式为机械通气控制呼吸，术中七氟醚保持2%～3%浓度范围。观察记录各组患儿的手术时间、拔管时间、苏醒时间、苏醒期躁动情况及Ramsay镇静评分。　结果　各组的手术时间、拔管时间以及苏醒时间，差异无显著性意义(P>0.05)。苏醒期躁动发生率A组、B组、C组分别为14.3%、2.9%和2.9%，与D组（34.3%）比较，差异具有显著性意义（P<0.05），A组与B组、C组比较，差异具有显著性意义（P<0.05）。PAED量化评分，A组（7.5±4.8）、B组（6.3±3.4）、C组（6.1±3.9）与D组（9.8±3.7）比较，差异具有显著性意义（P<0.05）。B组、C组Ramsay镇静评分显著低于A组、D组，差异有显著性意义（P<0.05）。　结论　右美托咪定能够有效降低七氟醚麻醉苏醒期患儿躁动发生率。0.7 μg/kg剂量的右美托咪定更适合应用于临床。

Abstract:

[Abstract]　Objective　To explore the effects of different doses dexmedetomidine for prevention of agitation induced by sevoflurane anesthesia in children, and to determine the optimal dosage.　Methods　One hundred and forty ASA Ⅰ-Ⅱ patients, who underwent abdominal surgery, were randomly divided into four groups: low dose dexmedetomidine (Group A, 0.4 μg/kg, n=35), middle dose dexmedetomidine (Group B, 0.7 μg/kg, n=35), high dose dexmedetomidine (Group C 1 μg/kg, n=35) and control group (Group D, saline, n=35). The dexmedetomidine groups were treated with intravenous infusion of dexmedetomidine 0.4 μg/kg, 0.7 μg/kg, 1 μg/kg and the control group was treated with intravenous infusion of the same volume of saline at 15 min before the induction of anesthesia. The anesthesia was induced by tidal volume method, mask and a breathing circuit preloaded with 8% sevoflurane, and the endotracheal intubation was performed after induction of anesthesia. Pressure control mode was applied using anesthesia machine for mechanical ventilation, and sevoflurane 2%~3% was used for maintaining the depth of anesthesia. The rate of agitation was determined using PAED and the sedation was determined using Ramsay scoring system. The results of anesthetic drugs were recorded.　Results　The duration of operation, the time to extubation and the time of recovery were similar among the four groups (P>0.05). The rates of agitation in awakening period were 14.3%,2.9%,2.9%,34.3% in the group A，group B，group C and group D, respectively. The rates of agitation in the group A, group B, and group C were lower than Group D and the differences were statistically significant (P<0.05). The PAED score were (7.5±4.8),(6.3±3.4),(6.1±3.9) and (9.8±3.7)in the group A,B,C and group D, respectively and the differences were statistically significant (P<0.05). The Ramsay sedation scores in the group B and group C were lower than the Group A and Group D, and the differences were statistically significant (P<0.05).　Conclusion　Dexmedetomidine could reduce agitation of sevoflurane anesthesia, and 0.7 μg/kg of the dexmedetomidine seems more suitable for prevention of agitation induced by sevoflurane anesthesia in children.