右美托咪定对小儿眼科全麻七氟烷最低肺泡有效浓度的影响  

Effect of dexmedetomidine on minimum alveolar concentration of sevoflurane in children undergoing inhalation anesthesia

作　　者：初丽艳[1] 潘楚雄[1] 

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,100730

出　　处：《北京医学》2017年第6期581-584,共4页Beijing Medical Journal

摘　　要：目的探讨右美托咪定对小儿眼科全凭吸入麻醉中七氟烷最低肺泡有效浓度(minimum alveolar concen-tration,MAC)的影响。方法选择择期行眼科斜视矫正手术患儿60例,年龄4~7岁,ASAⅠ~Ⅱ级。采用随机数字表法将患者随机分为对照组及右美托咪定组,每组30例。入室后监测ECG,HR,SPO_2,BIS等,开放静脉,给予阿托品0.02 mg/kg。两组均采用潮气量呼吸法面罩吸入4 L/min纯氧及7%七氟烷诱导;由同一位熟练掌握喉罩置入技术的麻醉医生置入喉罩,手术全程保留自主呼吸,并给予以下处理:对照组生理盐水10 ml,右美托咪定组将1μg/kg右美托咪定稀释至10 ml经10 min静脉缓慢泵注。10 min后遵循序贯实验的原则设定并调整挥发罐,使两组患者七氟烷呼出浓度达到设定值。手术开始眼部局麻时,观察并记录患儿循环及体动反应等情况。按照等比级设立5个阶梯:3.3%,3.0%,2.7%,2.4%,2.1%。每组首例患者初始呼气末浓度值均为3.0%,如出现体动或HR升高≥15%或BIS≥60,则下一例目标浓度提高一个阶梯;否则视为有效,下一例目标浓度降低一个阶梯。并按照序贯试验的方法计算得出两组MAC并进行比较。结果右美托咪定组MAC为2.57%,95%可信区间CI_B(2.56%,2.59%);对照组测定值2.90%,CI_A(2.89%,2.91%)低11.29%,两组结果差异有统计学意义(P<0.05)。此外,两组呼气末CO_2(P_(ET)CO_2)的数值对照组比右美托咪定组高5.18%,MV,P_(ET)SEV值右美托咪定组比对照组分别降低14.16%,15.26%,且差异有统计学意义(P<0.05)。结论保留自主呼吸的小儿眼科斜视矫正手术全凭吸入麻醉中,使用右美托咪定可显著减少七氟烷用量,其最低肺泡有效浓度降低为2.57%,95%可信区间为2.56%,2.59%。Objective To investigate the effect of dexmedetomidine on MAC of sevoflurane in children undergoing inhalation anesthesia, during the ophthalmologic operation. Methods Sixty aged 4-7 year-old, ASAⅠ-Ⅱ children who underwent squint correction, and without any premedication were selected. They were randomly divided into two groups, A （control group） and B （dexmedtomidine group）. After anesthetic induction and placement of intravenous line, the laryn- geal airway was set up, and patient was left in spontaneous ventilation. During the procedure, 1μg/kg dexmedtomidine was given by infusion pump in group B, while equal normal saline was given in group A, both of the medicine were given in 10 minutes. Ten minutes later, the concentration of sevoflurane was adjusted according to the Dixon sequential trails. During the local anesthesia, BP, HR, RR, PETCO2, and the depth of anesthesia and so on were monitored. After the procedure was completed, the anesthetic gas was discontinued, and the laryngeal airway was removed when the patient was aweak. Four levels of the sevoflurane concentration were set up, 3.3%, 3.0%, 2.7%, 2.4%, 2.1%. And the concentration of the first patient of each group was 3.0%. The next patient＇ s sevoflurane concentration would increased one level if the HR increased for 15% or the BIS increased for 60, otherwise the concentration would decreased for one level. Results The MAC of group B was 2.57%, CIB （2.56%, 2.59%）, while the MAC of group A was 2.90%, CIA（2.89%, 2.91%）, P 〈0.05, and there was significant difference between them. What＇ s more, the PETCO2 of group B was 5.18% higher than group A, the MV and PETSEV of group B were all lower than group A, and there were significantly different. Conclusion A dose of 1μg/kg dexmedtomidine given after induction can decrease the requirement of sevoflurane, and the MAC can decrease by 2 57%.

关 键 词：右美托咪定 小儿 七氟烷 最低肺泡有效浓度 

分 类 号：R726.1[医药卫生—儿科]