右美托咪定辅助下的静吸复合麻醉在小儿气管异物取出术的应用  

Application of Dexmedetomidine for the Assistance of the Intravenous Inhalation Anesthesia in the Process of Tracheobronchial Foreign Bodies Removal

作　　者：欧阳爱平[1] 刘诗文[1] 李优春[1] 李以平[1] 黄桂明[1] 

机构地区：[1]赣州市人民医院麻醉科,江西赣州341000

出　　处：《药品评价》2016年第15期27-30,41,共5页Drug Evaluation

基　　金：江西省卫生计生委科技计划(编号:20167215)

摘　　要：目的:探究分析右美托咪定辅助下静吸复合麻醉应用于小儿气管异物取出术的效果。方法:选2015年6月至2016年6月赣州市人民医院收治的90例行支气管镜检术患儿,随机平均分作三组:P组(丙泊酚+瑞芬太尼+表面麻醉)、D组(右美托咪定+丙泊酚+瑞芬太尼+表面麻醉)、L组(喉罩+丙泊酚+瑞芬太尼+右美托咪定)。患儿入室后经面罩吸入七氟醚5min,之后用2%利多卡因对气管内、咽喉部与舌根部行表面麻醉。在此基础上给予P组患儿静脉泵入瑞芬太尼0.1μg/(kg·min)、丙泊酚0.15mg/(kg.min)维持麻醉至手术结束。对于D组则在表面麻醉后将右美托咪定经微量泵按2μg/kg的负荷剂量以恒定速度在10min内泵完,其后将泵速调整为1μg/(kg·h),于此同时在表面麻醉后静脉泵入瑞芬太尼0.075μg/(kg·min)、丙泊酚0.075mg/(kg.min)维持麻醉至手术结束。L组与D组麻醉方式相同,但是在术前2mim可弯曲喉罩,各组均于表面麻醉15min后开始进行手术操作。比较三组各时刻麻醉诱导前(T_0)、表面麻醉后15min(T_1)、置镜后1min(T_2)、置镜后5min(T_3)患者的心率(heart rate,HR)、呼吸频率(respiratory rate,RR)、脉搏氧饱和度(SpO_2)、平均动脉压(mean arterial pressure,MAP),比较麻醉开始后、术中及术后不良反应包括呼吸抑制、恶心、心动过速、喉痉挛、心动过缓、躁动、呛咳等的发生率,观察经可弯曲喉罩行硬质支气管镜气管异物取出的成功率。在HR、RR、SpO_2、MAP的组间比较时,T_0时刻三组两两比较差异无统计学意义(P>0.05),T_1、T_2、T_3时刻,P组与D组、L组比较差异有统计学意义(P<0.05)。在HR、RR、SpO_2、MAP的组内比较时,除T_2与T_3时刻比较差异无统计学意义(P>0.05),其余时刻两两比较差异有统计学意义(P<0.05)。三组患儿麻醉过程中及术中、术后不良反应发生率的比较,D组与L组比较差异无统计学意义(P>0.05),P组与D组、L组呛咳、呼吸抑制的比�Objective： To explore the effect of dexmedetomidine assisted intravenous inhalation anesthesia in the process of tracheal foreign body removal. Methods： 90 children underwent bronchoscopy examination from June 2015 to June 2016 in the hospital were randomly divided into three groups： group P（propofol ＋ remifentanil ＋ surface anesthesia）, group D（dexmedetomidine Set ＋ propofol ＋ remifentanil ＋ surface anesthesia） and group L（laryngeal mask ＋ propofol ＋ remifentanil too NEH ＋ dexmedetomidine. Children after the burglary via face mask inhalation sevoflurane 5 min, with 2% lidocaine on trachea, throat and tongue for surface anesthesia. On this basis, P group received intravenous infusion of remifentanil 0.1μg/kg·min, propofol 0.15 mg/kg·min to maintain anesthesia to the end of the operation. In group D, after surface anesthesia in the dexmedetomidine set by micro pump according to the loading dose of 2μg/kg at a constant speed in 10 min pump end and subsequently adjust the pump speed for 1μg/kg/h, at the same time in surface anesthesia after intravenous infusion into remifentanil 0.075μg/ kg·min, propofol 0.075 mg/kg·min maintain anesthesia until the end of the operation. L group and D group with the same anesthesia, but in the preoperative 2 min the laryngeal mask can be bend, each group were on the surface anesthesia for 15 min before the operation. The time before induction of anesthesia（T0）, after surface anesthesia 15 min（T1）, set mirror after 1 min（T2）, placing the mirror after 5 min（T3） in patients with heart rate（HR）, respiratory rate（RR）, pulse oxygen saturation（SpO2）, mean arterial pressure（map）were compared between three groups, and adverse reactions including respiratory depression, nausea, heart rate, laryngospasm, tachycardia, slow, restlessness, cough, the incidence was observed by flexible laryngeal mask airway for rigid bronchoscopy tracheal foreign body removal success rate. Results： The levels of HR, RR, SPO2 and MAP in the t

关 键 词：右美托咪定 静吸复合麻醉 小儿气管异物取出术 

分 类 号：R726.1[医药卫生—儿科]