右旋美托嘧啶对患儿全麻术后苏醒的影响  

Effect of dexmedetomidine on postoperative recovery in children with general anesthesia

作　　者：邓嘉陵 李军祥[2] 杨小霖[2] 

机构地区：[1]南充市东方医院麻醉科 [2]川北医学院附属医院麻醉科,四川南充637000

出　　处：《川北医学院学报》2014年第3期281-284,共4页Journal of North Sichuan Medical College

基　　金：南充市科技局支撑项目(110A0076)

摘　　要：目的：观察右旋美托嘧啶对患儿全麻下行脊柱裂矫正术后恢复情况的影响。方法：将40例8～12岁行脊柱裂矫正术的患儿随机分为两组，术中分别输注右旋美托嘧啶和等容量生理盐水，调节七氟烷浓度维持BIS值45～55。记录术中七氟烷和芬太尼用量、麻醉恢复情况、补救芬太尼用量。采用改良客观疼痛评分（modified objective pain score, OPS）、苏醒期激惹评分（agitation cole score，ACS）以及改良Aldrete评分（modified aldrete score, MAS）等评估患儿术后疼痛、烦躁及苏醒情况。术后若OPS≥4或ACS≥4 超过5 min，给于芬太尼0.5～1 μg/kg进行补救镇痛。结果：两组患儿术中情况比较，右旋美托嘧啶组的芬太尼、补救芬太尼、七氟烷用量较对照组少（P＜0.05）。两组麻醉恢复时间、术中低血压和心动过缓发生率无显著差异。两组患儿术后情况，右旋美托嘧啶组拔管后即刻疼痛明显（OPS≥4）的发生率、补救镇痛芬太尼量和术后恶心呕吐（PONV）发生率均少于对照组（P＜0.05）；达到MAS=10的时间短于对照组（P＜0.05）；初次需要芬太尼的间隔时间晚于对照组（P＜0.05）。两组患儿术后烦躁和寒颤的发生率无统计学意义。结论：脊柱裂矫正术患儿术中应用右旋美托嘧啶，术后有一定的持续镇痛作用，有助于减少术后烦躁的发生，提高麻醉恢复质量。Objective：The aim of this research was to observe the effect of postoperative recovery of dexmedetomidine in the spinal hifida diorthosis of children with general anesthesia. Methods：40 children underwent spinal bifida diorthosis, aged 8 to 12, were randomly divided into two groups to receive either dexmedetomidine or volume matched saline（placebo）. Inhaled sevoflurane concentration was adjusted to keep the bispectral index value between 45 and 55. Intraoperative hemodynamics,intraoperative fentanyl and sevofiurane consumption,and postoperative recovery profile and fentanyl consumptions were recorded. The conditions of postoperative pain, emergence agitation,and discharge time from postanesthesia care unit were evaluated using the modified objective pain score,agitation Cole score,and modified Aldrete score,respectively. Fentanyl 0. 5 - 1 μg/kg was administered for pain when objective pain score ≥4 or severe EA（ agitation Cole score） = 4 or 5 lasting over 5 minutes. Results：The intraoperative consumption of sevoflurane and fentanyl in dexmedetomidine group was significantly less than that in control group （ P 〈 0. 05 ）. Postoperatively, the children in dexmedetomidine group had less pain and agitation scores（P 〈 0. 05 ）, and a shorter time to achieve full modified Aldrete score（ P 〈 0.05 ）. Compared with the control group, a less postoperative consumption of fentanyl, a longer time needed for the first analgesic requirement, and a lower incidence of postoperative nausea and vomiting were found in the dexmedetomidine group（ P 〈 0. 05 ）. Conclusion ：Intraoperative use of dexmedetomidine in children undergoing spinal surgery results in a favorable recovery with reduced postoperative pain and emergence agitation,and a better recovery quality from general anesthesia.

关 键 词：右旋美托嘧啶 全麻 术后苏醒 患儿 

分 类 号：R726.1[医药卫生—儿科]