术前应用右美托咪定复合氟比洛芬酯对小儿扁桃体摘除术后躁动的影响  

The clinical application of advanced treatment of flurbiprofen and dexmedtomidine in tonsillectomy of children

作　　者：易声华[1,2] 陈忠华[2] 胡双燕[2] 仲俊峰[2] 李军[1] 

机构地区：[1]温州医学院附属二院麻醉科 [2]浙江省绍兴市人民医院麻醉科

出　　处：《中国临床药理学与治疗学》2013年第9期1044-1048,共5页Chinese Journal of Clinical Pharmacology and Therapeutics

摘　　要：目的：观察超前应用右美托咪定复合氟比洛芬酯在小儿扁桃体摘除术苏醒期的安全性和有效性。方法：60例ASA工级4～12岁行扁桃体摘除术的惠儿，随机分为3组（n=20）：对照组（Ⅰ组）、氟比洛芬酯组（IⅠ组）、氟比洛芬酯联合右美托咪定组（Ⅲ组），麻醉诱导前分别静注生理盐水2mL、1mg／kg氟比洛芬酯、1mg／kg氟比洛芬酯及0．5ttg／kg右关托咪定。所有患儿均采用咪达唑仑-芬太尼-罗库溴铵异丙酚静脉麻醉诱导、七氟炕吸入维持麻醉。记录3组患儿拔管后各时点血压、心率、麻醉后躁动评分（PAED）和疼痛评分（CHIPPS）、术后恶心呕吐的发生率。结果：Ⅲ组患儿术中和复苏期间芬太尼追加量较Ⅰ组显著减少（P〈0．05）；3组复苏室低氧血症的发生率分别为25％、20％和5％，Ⅲ组发生率明显降低（P〈0．01）；与工和Ⅱ组比较，Ⅲ组恶心呕吐发生率（30oA）减少（P〈0．01）。与Ⅰ组比较，Ⅲ组心率在拔管后5、10min均下降（P〈0．05）。Ⅲ组PAED评分在拔管即刻、拔管后5、10min较Ⅰ组低（P〈0．01），Ⅲ组CHIPPS评分在拔管即刻、拔管后5min较Ⅰ组低（P〈0．05）。3组患儿麻醉后睁眼时间和拔管时间无统计学差异（P〉0．05）。结论：小儿扁桃体摘除术术前应用氟比洛芬酯联合右美托咪定可以减轻术后疼痛，减少术后躁动、恶心呕吐的发生率，且不影响患儿的苏醒时间。AIM： To investigate the effects of advanced using flurbiprofen and dexmedetomi- dine in children undergoing tonsillectomy. METHODS： 60 children undergoing tonsillecto- my were randomly divided into 3 groups, the control group （group Ⅰ , n = 20）, flurbiprofen group （ groupⅡ , n = 20 ）, flurbiprofen and dexmedetomidine group （groupⅢ ,n=20）. Chil- dren were received 2 mL saline, 1 mg/kg fiurbi profen, 1 mg/kg fiurbiprofen and 0.5 μg/kg dexmedetomidine before induction in each group respectively. After intravenvous induction, all children were maintained with sevoflurane. Blood pressure and heart rate were recorded dur- ing operation. Agitation Scale （pediatric anes- thesia emergence delirium,PAED） and analgesia （children and infants postoperative pain scale, CHIPPS） was assessed at extubation and after 5,10, 15,30 minutes. RESULTS ： Compared with group I , there were significant reduction in peri- operative and postanesthetic recovery dosage of fentanyl in groupⅢ. The occurrence of hypox- emia in PACU were 25%,20~/oo and 5o/oo in group Ⅰ, ⅡandⅢ respectively. The occurrence of hypoxemia in group Ⅲ was significantly lower（P d0.01） and the same as incidence of postopera tive nausea and vomiting （30%）（P〈0.01）. In comparison with group i, there were slower heart rate in postextubation 5 and 10 minutes, decreased PAED score and CHIPPS scale in time of extubation, postextubation 5 minutes,10 mi- nutes in groupⅢ. No difference was observed about time of eye open and extubation among three groups. CONCLUSION. Advanced use flurbiprofen and dexmedetomidine can relieve pain, provide stable hemodynamics and reduce incidence of postoperative nausea, vomiting and agitation.

关 键 词：氟比洛芬酯 右美托咪定 扁桃体切除 儿童 

分 类 号：R614[医药卫生—麻醉学]