右旋美托咪定滴鼻用于小儿腭裂整复术麻醉中的临床研究  

Clinical research of intranasal administration of dexmedetomidine in pediatric palatorrhaphy surgery

作　　者：雷蕾[1,2] 康伟[1,2] 翁小玲[1,2] 夏璇[1,2] 姚林川[1,2] 颜玉桦[1,2] 

机构地区：[1]广东省口腔医院 [2]南方医科大学附属口腔医院麻醉科,广东广州510280

出　　处：《广东牙病防治》2015年第3期147-151,共5页Journal of Dental Prevention and Treatment

摘　　要：目的 观察右旋美托咪定（dexmedetomidine,Dex）滴鼻在小儿腭裂整复术中对血流动力学及麻醉并发症的影响。方法 60例腭裂患者随机分为Dex组和对照组,每组30例。静脉推注咪达唑仑0.1 mg/kg、丙泊酚2.0 mg/kg、芬太尼2.0μg/kg、琥珀胆碱1.5 mg/kg快速诱导后,经口腔气管插管。气管插管后Dex组按1.0μg/kg的剂量经鼻滴入稀释至0.4 m L的Dex,对照组滴入0.4 m L生理盐水。麻醉维持全程使用七氟醚维持至术毕。术中维持脑电双频谱指数在45-55、呼末二氧化碳分压（PETCO2）35-50 mm Hg。记录诱导完（T0基础值）、滴鼻后5 min（T1）、分离腭瓣时（T2）、手术结束时（T3）、拔除气管导管时（T4）、拔除气管导管后15 min（T5）6个时点血流动力学数据;术后睁眼时间（术毕至睁眼时间）、麻醉苏醒时间（停药至离室时间）、拔管时间（术毕至拔管时间）及拔管后不良反应发生的情况。结果 与对照组比较,Dex组的平均动脉压在T2为（8.64±0.65）k Pa、T3为（8.73±0.96）k Pa、T4为（9.06±0.83）k Pa,各时点均明显降低（P〈0.05）;心率在T1、T2、T3、T4、T5点有不同程度的降低;躁动、呛咳与对照组比较均明显减少（P〈0.01）。结论 小儿腭裂整复术中,诱导后应用1.0μg/kg Dex滴鼻可使患儿术中及拔管期血流动力学更平稳,躁动、呛咳发生率低,且不影响麻醉苏醒时间及拔管时间。Objective To investigate the effects of intranasal administration of dexmedetomidine on hemodynamic changes and anesthetic complications in pediatric palatorrhaphy. Methods Sixty patients with cleft palate were randomly assigned to Dex group and control group, with 30 cases in each group. The patients were injected intravenously in the following sequence with midazolam （0. 1 mg/kg） , propofol （2.0 mg/kg） , fentanyl （2.0 μg/kg） and succinylcholine （ 1.5 mg/kg） for rapid induction and then oral trachea eannula. Dex group after induction by 1.0 μg/kg dose of nasal drip into the dilution to 0.4 ml of Dex, control group into 0.4 ml saline . Anesthesia was maintained with sevoflurane until finish. During operation, bispectral index was maintained at 45 -55 and PET CO2 was maintained at 35 -50 mmHg. The data of hemudynamics were recorded after induction （ To, baseline）, 5 minutes ＇after intranasal Dex （ T1 ）, the time of separating palatal flap （ T2 ） , at the end of the surgery （ T3 ） , the time of extubation （ T4 ） and 15 minutes after extubation （ T5 ）. Times to eye-opening, recovering from anesthesia and extubation, adverse reactions after extubation were observed and recorded. Results Compared with control group, the mean arterial pressure in Dex group at T2 - T4 significantly decreased （ P 〈 0.05）, heart rate at T1 - T4 decreased in different degrees, the incidence of restlessness and bucking were significantly decreased （P 〈 0.01 ）. Conclusion In pediatric palatorrhaphy, intranasal administration of dexmedetomidine （ 1.0 μg/kg） after induction is effective to maintain hemodynamic stability during operation and extubation, the incidence of restlessness and bucking could be decreased, moreover it doesn＇ t affect the time of anesthesiae mergence and extubation.

关 键 词：右旋美托咪定 腭裂整复术 鼻 儿童 小儿 

分 类 号：R782.054[医药卫生—口腔医学]