术中使用右旋美托咪定或吗啡对儿童扁桃体腺样体切除术后镇痛的影响  

Comparison of intra-operative dexmedetomidine and morphine for postoperative analgesia in children after adenotonsillectomy

作　　者：庄培钧[1] 王炫[1] 张学锋[1] 周志坚[1] 王勤[1] 

机构地区：[1]复旦大学附属儿科医院麻醉科,上海201102

出　　处：《上海医学》2011年第4期271-274,共4页Shanghai Medical Journal

摘　　要：目的采用随机、对照和双盲设计评价术中使用右旋美托咪定或吗啡对儿童扁桃体腺样体切除术后镇痛的影响,探讨右旋美托咪定能否在此类手术中替代吗啡。方法选择因睡眠呼吸暂停综合征而择期行扁桃体腺样体切除术的患儿60例,2～13岁,美国麻醉医师学会分级Ⅰ～Ⅱ级,术前口服对乙酰氨基酚15mg/kg。将其随机分为两组,每组30例:D组麻醉诱导时予右旋美托咪定1μg/kg;M组诱导时予吗啡100μg/kg。术中记录心率(HR)、收缩压(SBP)、舒张压(DBP)、呼气末二氧化碳分压(petCO2)和氧饱和度。在术后即刻及15、30、45、60min应用东安大略儿童医院疼痛评分量表(CHEOPS评分表)进行术后疼痛评分,应用Ramsey镇静评分表对镇静程度进行评分。并对术后是否需要吗啡补救进行生存分析。结果 D组的petCO2显著低于M组(P<0.01);D组的CHEOPS疼痛评分略高于M组,但差异无统计学意义(P>0.05);两组Ramsey镇静评分的差异无统计学意义(P=0.099)。术后60min,M组无需吗啡补救镇痛的患者比例为70.0%(21/30),显著高于D组的43.3%(13/30,P=0.037)。结论右旋美托咪定对儿童扁桃体腺样体切除术后的呼吸抑制作用比吗啡弱,且能提供类似的术后镇痛作用,可以在儿童扁桃体腺样体切除术中作为一个可供临床选择的麻醉药物。Objective To compare postoperative analgesia effects of intra-operative dexmedetomidine and morphine in children after adenotonsillectomy by using a randomized, controlled and double-blind clinical trial, so as to determine whether dexmedetomidine can substitute morphine in the operation. Methods Sixty children receiving adenotonsillectomy due to obstructive sleep apnea syndrome, at an age of two to thirteen and American Society of Anesthesiologists physical status I or II, were randomly divided into two groups with 30 cases each. Children in group D received dexmedetomidine 1 μg/kg over 10 min in induction. Children in group M received morphine 0.1 mg/kg in induction. All children received oral paracetamol 15 mg/kg half an hour preoperatively. CHEOPS and Ramsey scores were used to evaluate pain and sedation at immediately, and 15, 30, 45 and 60 min after operation by a professional nurse working in Post Anesthesia Care Unit. Heart rate, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, end-tidal carbon dioxide （petCO2） and oxygen saturation were recorded at above time points. Postoperative rescue morphine was also analyzed. Results The petCO2 was lower in Group D than in Group M （P〈0.01）. The CHEOPS scores were higher in Group D than those in Group M （P〈0.05）. There was no significant difference in Ramsey scores between 2 groups （P=0.099）. In 60 min after operation, there were 70.0% patients （21/30） in Group M needing no postoperative rescue morphine, significantly higher than that in Group D （43.3%, 13/30, P=0.037）. Conclusion Dexmedetomidine has less respiratory depression for children after adenotonsillectomy, but can provide moderate analgesia as morphine. Dexmedetomidine can be used as a novel anaesthetic drug for adenotonsilllectomy in children.

关 键 词：右旋美托咪定 扁桃体腺样体切除术 呼吸抑制 

分 类 号：R766.9[医药卫生—耳鼻咽喉科]