右美托咪啶口服对小儿扁桃体术前术后镇静镇痛效果探讨  

The effect of the oral administration of dexmedetomidine on sedation in pediatric tonsillectomy at pre-and post-operation

作　　者：魏丕红[1] 杨在启[1] 马桂芬[1] 

机构地区：[1]泰安市中心医院麻醉科,山东泰安271000

出　　处：《临床医药文献电子杂志》2016年第46期9094-9096,共3页Electronic Journal of Clinical Medical Literature

摘　　要：目的 探讨口服右旋美托咪啶对小儿扁桃体切除术前镇静、术后镇静、镇痛、急性躁动的效果。方法 选择我院2013年9月～2014年9月收治扁桃体切除术患儿80例作为研究对象，80例ASA I-II级行扁桃体手术的患儿，随机分为对照组（C组）和右美托咪定组（D组），各40例，D组术前1 h口服含有2.5 μg/kg右美托咪定糖浆10 mL，C组术前1 h口服10 mL糖浆，麻醉诱导采用丙泊酚1～2 mg/kg、罗库溴铵0.6 mg/kg、芬太尼2 μg/kg，病人术中以2%七氟醚、6～10 μg/kg/h瑞芬太尼维持，手术结束停止吸入七氟醚和瑞芬太尼泵人，静推1 mg/kg氟比洛芬酯。观察记录患儿不同时间点血流动力学的指标及服药后30 min时的镇静评分、与父母分离时的情绪状态以及麻醉结束至睁眼时间。结果 两组患儿在年龄、体重、性别比及手术时间等指标上的比较，差异无统计学意义（P＞0.05）。D组T1时HR明显下降，D组在T1-T5时MAP及HR均较C组低，尤其是T4和T5两个时间点，差异有统计学意义（P＜0.05）。C组和D组RSS评分分别为（2.5±0.5）和（2.7±0.5），差异无显著差异（P＞0.05）。C组的首次睁眼时间是（8.5±4.0）min，D组的为（9.2±5.0）min，两组无显著差异（P＞0.05）。C组病人躁动的发生率为36%，D组病人的发生率为16%，两组相比有显著差异（P＜0.05）。结论 口服右旋美托咪啶可有效预防小儿扁桃体术后急性躁动。Objective To study the effect of the oral administration of dexmedetomidine on sedation in pediatric tonsillectomy at the time of preoperation and postoperation sedation, analgesia and acute agitation.Methods Eighty pediatric patients（ASA I-II） underwent tonsil surgery, were randomly divided into control group（group C）and dexmedetomidine group（group D）, 40 cases in each group, the patients in C and D group were respectively treated orally 10 ml syrup with or without 2.5 μg·kg-1 dexmedetomidine at 1 h preoperative,respectively.Then all patents were anesthetized by 1-2 mg/kg of propofol, 0.6 mg/kg rocuronium 2 μg/kg fentanyl and maintained by 2% sevoflurane, remifentanil 6-10 μg/kg/h, sevoflurane and remifentanil until the end of the operation,1mg/kg flurbiprofen was then infused for waking.The hemodynamic indexes, the sedation score after taking syrup and the emotional state when separation with their parents were evaluated. Moreover, time to eyes opening（TEO）was also recorded at the end of anesthesia. Results No significant difference was found on the age, weight, gender and operation between 2 groups（p〉0.05）while decreased MAP and HR was found at the time point T1 and T5 in Group D when compared to Group C, and significant difference was found at T4 and T5（p〈0.05）.Moreover the RSS score and TEO were respectively（2.5±0.5）and（2.7±0.5）, and（8.5±4.0）min and（9.2±5.0）min, which showed no difference between 2 groups. The presence of agitation was respectively 36% in group C and 16% in group D, which showed significant difference between these groups（p〈0.05）. Conclusion Oral administration of dexmedetomidine can effectively prevent acute agitation in children after tonsillectomy.

关 键 词：右旋美托咪啶 扁桃体切除术 镇静 镇痛 术后躁动 

分 类 号：R725[医药卫生—儿科]