术前应用右美托咪定对学龄前儿童的安全性探讨  

The safety of preoperative use of dexmedetomidine in preschool children

作　　者：刘桂祯[1] 刘斐[1] 孙玉川[1] 

机构地区：[1]山东省烟台市莱阳中心医院麻醉科,265200

出　　处：《中国医师进修杂志》2013年第33期23-25,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨术前应用右美托咪定对学龄前儿童术前配合程度、术中血流动力学的影响.方法 选择择期行下腹部手术的学龄前患儿100例,按随机数字表法分为治疗组和对照组,每组50例.治疗组采用右美托咪定0.5μu/g（稀释至20 ml）,对照组为等容量0.9％氯化钠,单次静脉微量泵注,20 min内注射完毕.采用诱导期合作度量表（ICC）评定患儿诱导期合作程度;记录围手术期监测病房泵注前（T1）、病房泵注结束（T2）、麻醉诱导前（T3）、麻醉诱导后（T4）、手术切皮时（T5）、手术结束即刻（T6）平均动脉压（MAP）、心率、脉搏血氧饱和度（SpO2）,呼气末二氧化碳分压（PE.TCO2）变化.结果 治疗组ICC评分为（2.73±0.12）分,明显低于对照组的（6.17±0.91）分,差异有统计学意义（P＜0.05）.治疗组ICC评分0分48例,ICC评分＞5分2例;对照组ICC评分0分3例,ICC评分＞5分47例,两组比较差异有统计学意义（P＜0.05）.两组T1、T2、T4时MAP、心率比较差异无统计学意义（P＞0.05）;治疗组T3、T5、T6时MAP、心率明显低于对照组,差异有统计学意义（P＜0.05）.对照组T3、T5、T6时MAP、心率明显高于本组T1时,差异有统计学意义（P＜0.05）.治疗组患儿各时间点MAP、心率与本组T1比较差异无统计学意义（P＞0.05）.两组间和组内各时间点SpO2、PETCO2比较差异无统计学意义（P＞0.05）.结论 术前应用右美托咪定干预,麻醉诱导及手术平稳,患儿康复时间缩短.Objective To explore the degree of cooperation and the effect of hemodynamics in preschool children who received preoperative use of dexmedetomidine.Methods One hundred preschool children who scheduled for lower abdominal operation were randomly divided into two groups,each 50patients.The treatment group was given bolus infusion dexmedetomidine 0.5 μ g/kg （20 ml）,the control group was given bolus infusion 0.9％ sodium chloride 20 ml.They were completed in 20 min.The cooperation was assessed by induction compliance checklist （ICC） score,and the level of mean arterial pressure （MAP）,heart rate（HR）,pulse oxygen saturation（SpO2）,end-tidal pressure of carbon dioxide（PnCO2） at monitoring ward before bolus infusion （T1）,end of bolus infusion （T2）,before induction （T3）,after induction （T4）,incised skin （T5） and end of operation （T6） were compared.Results The scores ofICC in treatment group was significantly lower than that in control group [（2.73 ± 0.12） scores vs.（6.17 ± 0.91） scores] （P ＜ 0.05）.In treatment group,48 patients ICC score was 0,2 patients ICC score ＞5 scores,and in control group,there was 48,2 patients,there was significant difference（P ＜ 0.05）.The level of MAP,HR at T1,T2,T4between two groups had no significant difference （P ＞ 0.05）.The level of MAP,HR at T3,T5,T6 in treatment group were significantly lower than those in control group（P ＜ 0.05）.In control group,the level of MAP,HR at T3,T5,T6 were significantly higher than those at T1 （P ＜ 0.05）.In treatment group,the level of MAP,HR at T2-T6 had no significant difference compared with T1 （P ＞ 0.05）.The level of SpO2,PnCO2 between two groups and interclass had no significant difference （P ＞0.05）.Conclusion Bolus infusion dexmedetomidine before operation can improve the induction of anesthesia and operation smoothly,and improve the patients early rehabilitation.

关 键 词：焦虑 血流动力学 儿童 学龄前 应激反应 右美托咪定 

分 类 号：R726.1[医药卫生—儿科]