右美托咪定持续输注对小儿全凭静脉麻醉苏醒期拔管反应及躁动的影响  

Effects of continuous infusion of dexmedetomidine on extubation response and emergence delirium in pediatric under total intravenous anesthesia

作　　者：周密[1,2] 许晓东[1,2] 舒爱华[1,2] 

机构地区：[1]三峡大学人民医院 [2]湖北省宜昌市第一人民医院麻醉科,湖北宜昌443000

出　　处：《中国医药导报》2015年第7期67-70,共4页China Medical Herald

摘　　要：目的观察右美托咪定（dexmedetomidine Dex）持续输注对小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期拔管反应及躁动的影响。方法将60例择期全凭静脉麻醉下行扁桃体腺样体切除术患儿,随机分为右美托咪定（D组）和对照组（C组）,麻醉诱导后分别持续静脉泵入右美托咪定0.3μg/（kg·h）和等容量的生理盐水至手术结束。记录泵注右美托咪定前（T0）、泵注后5 min（T1）、10 min（T2）、拔管时（T3）、拔管后1 min（T4）、拔管后5 min（T5）、拔管后10 min（T6）的平均动脉压（MAP）、心率（HR）;记录停用麻醉药物至拔管时间、睁眼时间、拔管时呛咳反应评分;根据儿童麻醉后躁动评分（PAED）和改良加拿大东安大略儿童医院疼痛评分量表（m-CHEOPS）,拔管后每分钟对患儿进行躁动和疼痛评分,记录所得最高值作为监测有效值;记录躁动（Watcha评分≥3分）发生率。结果与T0比较,C组T3~T5时MAP和HR均显著升高（P〈0.05）;D组各时点MAP与HR比较,差异无统计学意义（P〉0.05）;与C组比较,D组T3~T5时MAP与HR均显著降低（P〈0.05）。两组患儿拔管时间、睁眼时间比较差异无统计学意义（P〉0.05）;D组拔管时呛咳反应评分[（1.4±0.5）分]显著低于C组[（2.3±0.7）分,P〈0.05],PAED评分D组[（8.4±1.6）分]显著低于C组[（13.2±2.0）分,P〈0.05],D组疼痛评分[（3.6±0.6）分]显著低于C组[（4.8±0.8）分,P〈0.05],D组躁动发生率（3.3%）显著低于C组（16.7%,P〈0.05）。结论右美托咪定持续输注[0.3μg/（kg·h）],能有效抑制小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期的拔管反应,减少术后躁动的发生,且不延长麻醉苏醒时间。Objective To observe the effects of continuous infusion of dexmedetomidine（dex） on extubation response and emergence delirium in pediatric adenotonsillectomy under total intravenous anesthesia（TIVA）. Methods 60 children undergoing adenotonsillectomy under TIVA were randomly divided into dexmedetomidine group（group D） and control group（group C）. Dexmedetomidine was infused at the rate of 0.3 μg/（kg·h） in group D and sodium chloride was infused at the same volume in group C until the end of the surgery after anesthesia induction. Mean artery pressure（MAP） and heart rate（HR） were recorded before drug delivery（T0）, 5（T1）, 10 min（T2） after administration, during extubation（T3） and 1（T4）, 5（T5）, 10 min（T6） after extubation. Time from stopping narcotic drugs to extubation and opening eyes and cough reflex score during extubation were recorded. According to the Pediatric Anesthesia Emergence Delirium（PAED） to mark the delirium of the patient per 5 minutes after extubation, the highest score was used to as effective value, and at the same time, mark the degree of pain according to the modified Children′ s Hospital of Eastern 0ntario Pain Scale.The incidence rate of postoperative agitation was recorded. Results Compared with T0, MAP and HR at T3-T5 in group C were significantly higher（P〈0.05）, MAP and HR in group D at each time was no significant difference（P〈0.05）.Compared with group C, MAP and HR at T3-T5 in group D were significantly lower（P〈0.05）. There was no significant difference in extubation time and opening eyes time between the two groups（P〈0.05）. Cough reflex score of group D[（1.4±0.5） scores] was significantly lower than that of the group C [（2.3±0.7） scores]（P〈0.05）, PAED of group D [（8.4±1.6） scores] was significantly lower than that of the group C [（13.2±2.0） scores]（P〈0.05）, pain score of group D[（3.6±0.6） scores] was significantly lower than that of the group C [（4.8±0.8） score

关 键 词：右美托咪定 全凭静脉麻醉 拔管反应 躁动 

分 类 号：R614[医药卫生—麻醉学]