不同剂量右美托咪定静脉泵注在儿童门诊术前用药的临床研究  

Clinical Research of Different Doses of Dexmedetomidine for Premedication in Out-Patient Children

作　　者：杨飞[1] 徐颖[1] 涂生芬[1] 刘立飞[1] 

机构地区：[1]重庆医科大学附属儿童医院、儿童发育疾病研究教育部重点实验室、儿科学重庆重点实验室,重庆400014

出　　处：《儿科药学杂志》2016年第4期12-15,共4页Journal of Pediatric Pharmacy

基　　金：国家自然科学基金,项目编号31200853;重庆市自然科学基金,项目编号cstc2012jj A10036;国家临床重点专科建设项目资助,项目编号:国卫办医函[2013]544

摘　　要：目的：研究术前静脉泵注不同剂量的盐酸右美托咪定（DEX）在儿童门诊手术术前用药的临床效果,探讨门诊手术患儿静脉泵注DEX作为术前用药的合理剂量。方法：选取门诊疝囊高位结扎术患儿75例,年龄1~6岁,ASA分级Ⅰ或Ⅱ级,随机分为DEX 1.00μg/kg（D1.00）组、0.75μg/kg（D0.75）组、0.50μg/kg（D0.50）组各25例。由家长陪同进入麻醉准备室,三组患儿分别于10 min静脉泵注DEX 1.00μg/kg、0.75μg/kg、0.50μg/kg,用药30 min后进入手术室进行手术。记录用药前（T0）、用药后10min（T10）、用药后20 min（T20）、用药后30 min（T30）的心率、平均动脉压和血氧饱和度,并于T10、T20、T30记录患儿镇静评分、儿童麻醉诱导合作评分、患儿入睡所需时间（镇静评分达4分）、术后苏醒时间、术后谵妄发生率及术中心动过缓和低血压发生率。结果：D0.75组与D1.00组镇静评分、麻醉诱导合作评分和入睡时间比较差异无统计学意义,但D1.00组较D0.75组患儿术中心动过缓和低血压发生率显著升高（P〈0.05）。D0.75组与D0.50组用药后生命体征变化、术中心动过缓和低血压发生率以及术后谵妄发生率比较差异无统计学意义,但D0.50组较D0.75组入睡所需时间延长,同时麻醉诱导合作评分降低（P〈0.05）。结论：DEX作为儿童术前用药,对自主呼吸没有抑制作用,对生命体征影响小,且静脉泵注0.75μg/kg DEX较0.50μg/kg和1.00μg/kg为更适合的术前用药剂量。Objective： To investigate the effects of different doses of dexmedetomidine（ DEX） for premedication in out-patient children,and to identify the most suitable dose of DEX. Methods： Seventy-five children undergoing high ligation of hernia sac,aging 1to 6 years old,ASA I to II,were randomly divided to 3 groups（ n = 25） ： group D1.00（ 1.00 μg/kg DEX）,group D0.75（ 0.75 μg/kg DEX）and group D0.50（ 0. 50 μg/kg DEX）. We recorded HR,MAP and Sp O2 before pre-administration（ T0） and 10,20,30 min after administration（ T10,T20,T30）. Sedation scale,the induction cooperation scale（ ICS）,the time for sleep（ sedation score arrives at 4）,the recovery time and the incidences of adverse effects were recorded at the time points of T10,T20 and T30. Results： Compared with group D1.00,there were no significant differences in sedation scale,ICS and the time for sleep of group D0.75,but the incidences of bradycardia and low blood pressure were markedly decreased in group D0.75（ P〈0. 05）. Compared with group D0.50,there were no significant differences in HR,MAP,Sp O2 and the incidences of bradycardia and low blood pressure and postoperative delirium of group D0.75,but the time for sleep was markedly decreased and the ICS was markedly increased in group D0.75（ P〈0.05）. Conclusion： DEX has no inhibition to spontaneous breathing and has small impacts on the vital signs as children＇s preoperative medication. Compared with0.50 μg / kg and 1.00 μg / kg DEX,0.75 μg / kg DEX acts as the more suitable dose for premedication in out-patient children.

关 键 词：盐酸右美托咪定 术前用药 儿童 手术 

分 类 号：R726.1[医药卫生—儿科]