麻醉前含服不同剂量右美托咪定对七氟烷抑制小儿喉罩置入反应半数有效浓度的影响  

Effect of different doses of buccal dexmedetomidine before anesthesia on median effective concentration of sevoflurane required to prevent response to laryngeal mask airway insertion in children

作　　者：纪宏新[1] 邓玉春 陈文[1] 王嘉炜 李安学[1] JI Hong-xin;DENG Yu-chun;CHEN Wen;WANG Jia-wei;LI An-xue(Department of Anesthesiology,Longgang District People's Hospital of Shenzhen,Shenzhen GUANGDONG 518172,China)

机构地区：[1]深圳市龙岗区人民医院麻醉科,广东深圳518172

出　　处：《中国新药与临床杂志》2018年第11期646-650,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：深圳市科技计划项目(JCYJ20160422141605247);深圳市龙岗区科技发展资金项目(20170401100928470)

摘　　要：目的探讨麻醉前含服不同剂量右美托咪定(Dex)对七氟烷抑制小儿喉罩置入反应半数有效浓度(EC50)的影响。方法选择择期手术拟行全麻患儿,年龄1~3岁, ASA分级Ⅰ级,随机分为3组。吸入麻醉诱导前1 h, N组患儿经口含服氯化钠注射液1 m L, D2组、 D4组分别经口含服Dex 2、 4μg·kg-1(用氯化钠注射液稀释至1 m L)。入室后吸入5%七氟烷诱导,意识消失后按改良序贯法调整七氟烷呼气末浓度,起始为2%,依据喉罩置入反应确定下一例患儿增加或降低0.2%七氟烷呼气末浓度,直至出现七个交换点即研究结束。评估Dex给药45~60 min后患儿与父母分离镇静水平及吸入诱导患儿面罩接受程度。用概率单位回归分析法测定七氟烷抑制患儿喉罩置入反应的EC50及相应的95%可信区间(95%CI)。结果 N组、 D2组和D4组分别纳入患儿26、 27和28例。D4组患儿与父母分离满意率和面罩接受满意率均明显高于D2组和N组(P <0.05)。N组、 D2组和D4组七氟烷抑制患儿喉罩置入反应的EC50分别为2.02%(95%CI:1.73%~2.32%)、 1.77%(95%CI:1.47%~2.05%)和1.60%(95%CI:1.21%~1.82%)。结论麻醉前含服Dex 4μg·kg-1的镇静效果优于Dex 2μg·kg-1,含服Dex 2和4μg·kg-1可使七氟烷抑制小儿喉罩置入反应EC50分别降低12%和21%。AIM To investigate the effect of different doses of buccal dexmedetomidine before anesthesia on median effective concentration(EC50) of sevoflurane required to prevent response to laryngeal mask airway(LMA) insertion in children. METHODS ASA physical status Ⅰ children, aged 1 to 3 years, scheduled for general anesthesia were randomly divided into 3 groups: group D2 and D4 received 2 and 4 μg·kg-1 buccal dexmedetomidine(diluted with sodium chloride injection to 1 mL) and group N received the equal volume of sodium chloride injection instead at 1 h before induction of anesthesia. After the children lost consciousness by inhalation of 5% sevoflurane in oxygen, the designated end-tidal concentration using the modified Dixon’s upand-down method starting at 2% end-tidal concentration of sevoflurane by the response effect of the previous children, in an increment or decrement of 0.2%. The study ended until the seventh cross-over point was obtained in each group. Sedation status at separation from the parents and the child’s acceptance of face mask was evaluated after 45-60 min of the drugs administration. Probity analysis was used for calculating EC50 and95% confidence interval( CI) of sevoflurane required to prevent response to LMA insertion. RESULTS The group N, group D2 and group D4 were included 26, 27 and 28 cases respectively. The satisfactory rate of sedation at separation from the parents and the child’s acceptance of face mask of the group D4 were higher than the group D2 and group N(P < 0.05). The EC50 of sevoflurane required to prevent response to LMA insertion was 2.02% for the group N(95%CI: 1.73%-2.32%), 1.77% for the group D2(95%CI: 1.47%-2.05%)and 1.60% for the group D4(95%CI: 1.21%-1.82%). CONCLUSION Buccal dexmedetomidine in doses of4 μg·kg-1 produces better sedation effect than 2 μg·kg-1 before induction of anesthesia. Premedication with buccal dexmedetomidine 2 and 4 μg·kg-1 reduce the sevoflurane EC50 to prevent response to LMA insertion in children by 12% and 21% respectively.

关 键 词：右美托咪定 七氟烷 儿童 含服给药 喉罩通气道 半数有效浓度 

分 类 号：R971[医药卫生—药品]