右美托咪定骶管应用预防小儿尿道下裂成形术全麻苏醒期躁动  

Efficacy of Caudal Administration of Dexmedetomidine for Prevention of Pediatric Emergenceagitation after Hypospadias Plasty Under General Anesthesia

作　　者：王媛[1] 杜彬[2] 贾英萍[1] 

机构地区：[1]郑州市儿童医院麻醉科,河南郑州450053 [2]四川大学华西医院麻醉科,四川成都610041

出　　处：《四川医学》2015年第9期1216-1220,共5页Sichuan Medical Journal

摘　　要：目的：探讨右美托咪定骶管应用对小儿尿道下裂成形术全麻苏醒期躁动的预防效果。方法80例小儿Ⅲ型尿道下裂行尿道成形术的患儿,年龄3~6岁。随机分为4组：0．25%罗哌卡因骶管阻滞组（R组,n=20）；1μg/kg右美托咪定＋0．25%罗哌卡因骶管阻滞组（DR1组,n=20）；2μg/kg右美托咪定＋0．25%罗哌卡因骶管阻滞组（DR2组,n=20）；0．25%罗哌卡因骶管阻滞＋0．5μg/（kg·h）右美托咪定静脉泵注组（DVR组,n=20）。七氟醚诱导并放置喉罩后,持续吸入七氟醚（氧流量2L/min）并调整七氟醚浓度至BIS值维持在40~50。 DVR组静脉泵注0．5μg/（ kg·h）右美托咪定。其余三组在超声引导下骶管穿刺并注入1mL/kg各组药物（最大量不超过20mL）,术毕拔除喉罩送至复苏室。主要观察指标是拔除喉罩时（T1）的镇静-躁动评分（SAS评分）。次要观察指标包括术后2、4h（T2和T4）患儿Ramsay镇静评分,苏醒时间、不良事件和术后并发症发生率。结果与R组相比DR1、DR2、DVR组拔喉罩时SAS评分明显降低,T2和T4时点Ramsay评分明显升高。与DVR组相比,其余三组循环系统不良事件发生率明显减少。与DR1组相比,其余三组苏醒时间明显延长；而R组苏醒期药物镇静的使用率明显增高。 R组6例发生术后创面出血感染、2例发生尿道瘘。结论右美托咪定骶管应用明显降低苏醒期间躁动反应,且1μg/kg右美托咪定剂量效果最好,血流动力学稳定,苏醒快,术后并发症发生率降低。Objective To study the efficacy of caudal administration dexmedetomidine for prevention of pediatric emer-gence agitation after hypospadias plasty under general anesthesia. Methods Eighty children, aged 3~6 yrs, with type III hypos-padias scheduled for plastic surgery were included. The subjects were randomly allocated into 4 groups：0. 25% ropivacaine caudal injection（R group;n=20）;1μg/kg dexmedetomidine＋0. 25% ropivacaine caudal injection（DR1 group; n=20）;2 μg/kg dexmedetomidine ＋ 0. 25%ropivacaine caudal injection （ DR2 group; n =20 ）; 0. 25%ropivacaine caudal injection ＋ 0. 5μg/（kg·h）dexmedetomidine intravenous infusion（DVR group;n=20）. After induction with sevoflurane and LMA insertion, anesthe-sia was maintained by sevoflurane inhalation guided by BIS monitoring ranged from 40 to 50. In DVR group, dexmedetomidine was infused by a rate of 0. 5μg/（kg·h）until the end of surgery. In the other 3 groups, 1ml/kg of predefined drugs were caudal injected with the ultrasound guidance. The primary outcome was the Sedation-agitation score（ SAS） was recorded at the time of LMA removal （T1）. The secondary outcomes included Ramsay sedation score at 2 and 4 hour（T2 and T4）after the surgery, recovery time, the incidence of adverse events and postoperative complications. Results DR1, DR2 and DVR groups had significantly lower SAS scores at T1, and higher Ramsay score at T2 and T4 than R group. Compared with DVR group, the other 3 groups had significantly lower incidence of adverse circulatory effects. Compared with DR1 group, the other three groups had significantly longer recovery time. R group used sedatives more frequently during recovery. For postoperative outcomes, 6 in R group had wound infection, 2 had urethral fistula, otherwise well. Conclusion Dexmedetomidine caudal administration for hypospadias plasty surgery under general anesthesia reduce recovery agitation and provide stable hemodynamics, fast recovery, as well as effective prevention of postoperative complicati

关 键 词：右美托咪定 骶管麻醉 小儿 尿道下裂 苏醒期躁动 

分 类 号：R726.1[医药卫生—儿科]