右美托咪定或丙泊酚联合七氟烷维持麻醉对小儿苏醒期躁动的影响  

Emergence agitation in children undergoing adenotonsillectomy:a comparison between sevoflurane combined with dexmedetomidine and propofol for maintenance of anesthesia

作　　者：王宏[1] 靳天 刘刚[2] 陈启旭[2] 朱琳琳[2] 李士通[1] 

机构地区：[1]上海交通大学附属第一人民医院麻醉科,上海200080 [2]蚌埠医学院第一附属医院麻醉科

出　　处：《上海医学》2015年第8期639-642,共4页Shanghai Medical Journal

摘　　要：目的观察右美托咪定或丙泊酚联合七氟烷维持麻醉用于儿科手术对术后苏醒期躁动(EA)发生的影响。方法将60例3~12岁择期行扁桃体切除术的患儿随机分入对照组、右美托咪定组和丙泊酚组,每组20例。麻醉诱导后以七氟烷维持麻醉,对照组静脉注射0.9%氯化钠溶液2mL·kg^(-1)·h^(-1),右美托咪定组在10min内静脉注射右美托咪定1μg/kg后以1μg·kg^(-1)·h^(-1)维持,丙泊酚组静脉注射丙泊酚2mg·kg^(-1)·h^(-1),均至手术结束前5min。记录手术持续时间、七氟烷使用时间和拔除气管导管的时间。采用4分评分法和儿童麻醉苏醒期躁动(PAED)评分法评估EA发生情况。患儿4分评分法≥3分或PAED评分≥10分被认定为EA。记录苏醒期不良事件的发生情况。结果 3组手术持续时间和七氟烷使用时间的差异均无统计学意义(P值均>0.05)。右美托咪定组和丙泊酚组的拔除气管导管的时间均显著长于对照组(P值均<0.05),右美托咪定组显著长于丙泊酚组(P<0.05)。对照组4分评分法≥3分8例(40%),右美托咪定组3例(15%),丙泊酚组1例(5%);对照组PAED评分≥10分10例(50%),右美托咪定组5例(25%),丙泊酚组2例(10%)。右美托咪定组和丙泊酚组4分评分法≥3分和PAED评分≥10分的患儿比例均显著低于对照组(P值均<0.05),而右美托咪定组与丙泊酚组间差异均无统计学意义(P值均>0.05)。3组患儿在麻醉后恢复室期间均未出现恶心呕吐、喉痉挛和呼吸抑制的不良反应。结论右美托咪定或丙泊酚都能有效地抑制七氟烷麻醉术后小儿EA的发生,但丙泊酚复合七氟烷麻醉拔除气管导管的时间更短,是临床更为理想的选择。Objective To observe the effect of combined application of sevoflurane and dexmedetomidine （or propofol） for maintenance of anesthesia on the incidence of emergence agitation （EA） in pediatric surgery. Methods Sixty children, aged 3- 12 years, scheduled for adenotonsillectomy were randomly assigned to 3 groups （n = 20）, control group, dexmedetomidine group and propofol group. After anesthesia induction, sevoflurane was used to maintain anesthesia. Meanwhile, normal saline （2 mL · kg^-1 · h^-l）, dexmedetomidine （1 μg/kg in 10 rain followed by 1 μg · kg^-1· h^-1）, and propofol （2 mg · kg^-1· h^-1） were intravenously given in control group, dexmedetomidine group and propofol group, respectively until 5 minutes before the end of the surgery. The duration of surgery, the duration of sevoflurane administration, and extubation time were recorded. EA was assessed by the Four-Point scale and pediatric anesthesia emergence delirium （PAED） scale. EA was considered if patients had a score ≥3 on the Four-Point scale and ≥10 on the PAED scale. The incidence of adverse events was recorded during anesthesia recovery period. Results There were no significant differences in the duration of surgery or sevoflurane administration between groups （all P〉0.05）. Compared with control group, the extubation time were significantly increased in dexmedetomidine group and propofol group （both P〈0.05）.Compared with dexmedetomidine group, the extubation time was significantly shortened in propofol group （P〈 0.05）. There were 8 cases （40%） in control group, 3 cases （15%） in dexmedetomidine group and 1 case （5%） in propofol group in whom the score of Four-Point scale was more than 3. There were 10 cases （50%） in control group, 5 cases （25 % ） in dexmedetomidine group and 2 cases （10 % ） in propofol group in whom the score of the PAED scale was more than 10. Less patients had a score ≥3 on the Four-Point scale and ≥10 on the PAED scale in the dexmedetomidine grou

关 键 词：右美托咪定 丙泊酚 七氟烷 苏醒期躁动 

分 类 号：R726.1[医药卫生—儿科]