全麻复合右美托咪定在小儿腹腔镜隐睾固定术中的应用  

Application of general anesthesia combined with dexmedetomidine in pediatric laparoscopic cryptorchidopexy

作　　者：李国华[1] 周立民[1] 张文生[1] 王子申[1] 

机构地区：[1]泰山医学院附属医院麻醉科,山东泰安271000

出　　处：《临床和实验医学杂志》2017年第11期1142-1145,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的评估全麻复合右美托咪定用于小儿腹腔镜隐睾固定术的效果。方法择期腹腔镜隐睾固定术患儿40例。随机分为对照组(麻醉诱导前和术中持续泵入生理盐水,C组)和右美托咪定组(麻醉诱导前和术中持续泵入右美托咪定,D组),其余麻醉方法两组相同。进入手术室后,持续监测患儿的平均动脉压(MAP)、心率(HR)、脑电双频谱指数(BIS)及血氧饱和度(Sp O2),记录动脉穿刺成功即刻(时间点T0)、成功气管插管即刻(时间点T1)、成功CO2气腹即刻(时间点T2)、手术结束即刻(时间点T3)和患者拔管即刻(时间点T4)五个时间点的MAP、HR、血糖、血清肾上腺素(E)以及皮质醇(COR)的浓度。观察并记录患儿丙泊酚用量、复苏时间及并发症。结果 (1)循环指标比较:HR:D组T1、T2、T3和T4点HR值与C组同时间点相比均显著较低(P<0.05);MAP:D组T1和T3点MAP值与C组同时间点相比均显著较低(P<0.05)。(2)应激指标比较:E:D组T1、T2和T4点E值与对照组同时间点相比均显著较低(P<0.05);COR:D组T1、T2、T3和T4点COR值与C组同时间点相比均显著降低(P<0.05);血糖:T2和T4点D组血糖值比C组显著降低(P<0.05)。(3)术后苏醒状态比较:同C组比较,D组呼吸恢复时间显著缩短(P<0.05),拔管时间差异无统计学意义(P>0.05),异丙酚用量显著减少(P<0.05)。(4)并发症比较:两组患儿术后疼痛及躁动发生率,D组均明显低于C组(P<0.05)。结论全麻复合右美托咪定用于小儿腹腔镜隐睾固定术有助于维持术中血流动力学稳定,抑制应激反应,减少麻醉药物用量,降低复苏期间不良反应,值得临床推广应用。Objective To evaluate the effect of general anesthesia combined with dexmedetomidine on children undergoing laparoscopic cryptorchidopexy. Methods 40 pediatric patients undergoing laparoscopic cryptorchidopexy, were randomly divided into control group （C group） and dexmedetomidine group （D group）. HR, MAP, Sp02 and BIS were continuously monitored. HR, MAP, the concentration of glucose（Glu） epinephrine （E） and cortisol （COR） were recorded in the following moments： the time of artery puncture successfully （ TO） , the time of trachealintubation （T1） , the time of pneumoperitoneum （T2） , the time of the end of surgery （T3） , the time of tracheal extubation （T4）. The propofol （pro） dose, recovery time and complications were also recorded. Results ①The comparison of circulatory index： HR： group D T1 - T4 were significantly lower than the same time point of group C （ P 〈0.05） . MAP ： Group D T1, T3 were significantly lower than the same time point of group C （ P 〈0.05）.②The comparison of stress index： E： Group D T1, T2 and T4 were significantly lower than that same time point of group C （ P〈0.05）. COR ： Group D T1 , T2, T3 and T4 were significantly lower than that same time point of group C （ P 〈 0. 0 5 ） . Glu ： Group D T2, T4 was significantly lower than that same time point of group C （ P〈0.05） . ③Comparison of the resuscitation ： Compared with C group, re-spiratory recovery time of group D was significantly shorter （P 〈0.05） , extubation time of group D was no significant difference （P〉0.05） and Pro dosage of group D was significantly lower （ P 〈0. 05） . ④Comparison of the complications： The incidence of postoperative pain and agitation of group D were significantly lower than that of group C （ P〈0.05） . Conclusion General anesthesia combined dexmedetomidine for pediatric laparoscopic cryptorchidopexy can maintain intraoperative hemodynamic stability, inhibit stress reaction , reduce the dose

关 键 词：小儿 腹腔镜隐睾固定术 全身麻醉 右美托咪定 

分 类 号：R726.1[医药卫生—儿科]