右美托咪定在小儿颈动脉交感神经网膜剥脱术中的临床应用  

The Sedation Effect of Dexmedetomidine in Children Carotid Artery Sympathetic Nerve Retina Stripping Surgery Under Local Anesthesia

作　　者：郭云惠 谢磊 杨敏 

机构地区：[1]国家康复辅具研究中心附属康复医院麻醉科,北京100076

出　　处：《河北医学》2015年第5期730-733,共4页Hebei Medicine

基　　金：国家科技支撑项目;(编号:2012bai33b06)

摘　　要：目的：比较右美托咪啶（Dex）和丙泊酚全麻用于小儿局部浸润麻醉辅助颈总动脉交感神经膜剥脱术中的镇静效果和不良反应。方法：择期此类手术患儿50例,ASAⅠ～Ⅱ级,随机分为右美托咪啶组和丙泊酚组,每组25例。右美托咪啶组负荷量1.0μg/kg,维持量0.3μg·kg^-1·h^-1;丙泊酚组负荷量2.8mg/kg,维持量2.5mg·kg^-1·h^-1。负荷量后行局部浸润麻醉。记录进入手术室后5min、局部浸润麻醉前、局部浸润麻醉后3min、手术开始后15min、手术开始后30min及手术结束时BIS、HR、MAP、Sp O2值,同时进行Ramsay评分。结果：右美托咪啶组HR在局麻操作时、术中较基础值明显降低（P〈0.05）,也低于相同时点丙泊酚组HR。右美托咪啶组和丙泊酚组术中MAP较基础值降低（P〈0.05）,两组间比较未见显著性差异。两组在术中不同时间点镇静评分未见显著性差异,右美托咪啶组麻醉后及手术中BIS值低于丙泊酚组（P〈0.05）。右美托咪啶组术中Sp O2均在98%以上,大声呼唤小于7岁加以轻拍面颊均可唤醒,无体动发生;丙泊酚组术中Sp O2最低90%,3例患者需大声呼唤加拍手臂唤醒。结论：小儿局麻手术中,右美托咪啶可以产生与丙泊酚相似的镇静效果,且易唤醒、无呼吸抑制,更适用于小儿全麻辅助局麻颈动脉交感神经膜剥脱术中的镇静。Objective： To evaluate the sedative effect of dexmedetomidine and propofol and the correlation of the conscious condition and BIS carotid artery sympathetic nerve retina stripping surgery.Method： 50 patients,ASAⅠ ～ Ⅱ,who underwent carotid artery sympathetic nerve retina stripping surgery,were randomly divided into two groups based on the medications used for sedation： the dexmedetomidine group and the propofol group.In the dexmedetomidine group,the loading dose was 1.0μg / kg,followed by 0. 3μg·kg^-1·h^-1.In propofol group,the loading dose was 2.8mg / kg,followed by 2.5mg·kg^-1·h^-1. BIS,HR,MAP and Ramsay score were observed and recorded before and during the operation. Result： The Ramsay scores were same in the two groups and BIS were lower in dexmedetomidine group（ P〈0. 05）. HR in dexmedetomidine group was also lower than the propofol group（ P〈0.05）. Side effects of hopoxemia were observed only in the propofol group. Conclusion： Compared with propofol,dexmedetomidine appears to have more advantages in patient swith carotid artery sympathetic nerve retina stripping surgery under local anesthesia. In addition,the BIS is lower with dexmedetomidine sedation than propofol at the same sedative level.

关 键 词：右美托咪啶 丙泊酚 脑电双频指数 RAMSAY评分 

分 类 号：R726.1[医药卫生—儿科]