骶管应用右美托咪定对小儿全麻苏醒期躁动的影响  

Effects of caudal dexmedetomidine on emergence agitation in children during postanesthetic recovery

作　　者：郑昌健[1] 郭文俊[1] 金孝岠[1] ZHENG Changjian GUO Wenjun JIN Xiaoju(Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical college, Wuhu 241001, China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院麻醉科,安徽芜湖241001

出　　处：《皖南医学院学报》2017年第4期385-388,共4页Journal of Wannan Medical College

基　　金：皖南医学院中青年科研基金(F201427)

摘　　要：目的:探讨骶管中应用右美托咪定(Dex)对小儿全麻苏醒期躁动(EA)的影响。方法:选择择期行腹股沟疝修补术的患儿160例,年龄2~6岁,ASAⅠ~Ⅱ,无椎管内麻醉禁忌证。随机分为4组:0.25%布比卡因组(C组、n=40)、0.5μg/kg Dex+0.25%左旋布比卡因组(Dex1组、n=40)、0.75μg/kg Dex+0.25%左旋布比卡因组(Dex2组、n=40)、1μg/kg Dex+0.25%左旋布比卡因组(Dex3组、n=40),药液总量为10 m L。全麻诱导置入喉罩后行骶管麻醉,4组药物30 s推入骶管。分别予麻醉诱导前(T_0)、置入喉罩后即刻(T_1)、手术开始后10 min(T_2)、拔除喉罩即刻(T_3)、拔管后10 min(T_4)、30 min(T_5)监测平均动脉压(MAP)、心率(HR)、手术时间、苏醒时间、阿托品使用情况、躁动发生情况。拔管后记录1 h、2 h的FLACC疼痛评分、Ramsay镇静评分。结果:4组患儿年龄、体质量、手术时间差异均无统计学意义(P>0.05);T_0、T_1时刻,4组患儿HR、MAP无统计学意义(P>0.05)。T_2~T_5时刻,与C组相比,Dex2组、Dex3组HR、MAP明显下降(P<0.05)。与C组对比,Dex1组、Dex2组、Dex3组术后躁动发生率、术后疼痛明显减少(P<0.05),镇静水平明显增加(P<0.05)。结论:骶管应用Dex可减少小儿全麻苏醒期躁动发生率,具有镇静、镇痛作用,0.75μg/kg Dex不延长苏醒时间,同时心血管不良事件更少。Objective：To investigate the effects of caudal dexmedetomidine （Dex） on emergence agitation in children during postanesthetic recovery. Methods ： A total of 160 children, aged 2 to 6 years （ ASA Ⅰ - Ⅱ）, scheduled to undergo inguinal hernia repair without contraindications to spinal anesthesia, were randomized to receive 0.25% levobupivacaine （ group C, n = 40 ） , 0.5 μg/kg dexmedetomidine ＋ 0.25% levobupivacaine （ Dexl group, n = 40 ） , 0.75 μg/kg dexmedetomidine ＋ 0.25% levobupivacaine （ Dex2 group, n = 40） , or 1 μg/kg dexmedetomidine ＋ 0.25% levobupivacaine （ Dex3 group, n = 40） .The total amount was set to 10mL.Anesthetic was injected into the sacral canal within 30 s after general anesthesia induction and laryngeal mask air- way （LMA） insertion. Mean arterial pressure （ MAP ）, heart rate （ HR）, operative time, recovery time, one hour and two hour FLACC scores, Ramsay scores after larygeal mask removal and incidence of postanesthetic excitement were documented at different time points, including pre-anesthetic induction （ T0 ）, time of intubation （ T1 ） , 10 min after operation （ T2 ） , time of LMA removal （ T3 ） , 10 min after extubation （ T4 ） and 30 min （ T5 ） .Results ： There was no significant difference regarding the age,weight,operative as well as changes of HR and MAP at To and T1 in the 4 groups（P〉0.05） ,yet HR and MAP were significantly fallen in Dex2 and Dex3 groups at between T2 and T5 compared to group C （P〈0.05）.Children in Dex 1, Dex 2 and Dex 3 groups had lower incidence of postanesthetic excitement and postoperative pain than those in group C （P〈 0.05）, and the sedation appeared better.Conclusion：Caudal dexmedetomidine may reduce the incidence of emergence agitation in children during postancsthetic recovery, and produce better sedation and pain control effects.Dosage of 0.75 μg/kg Dex will not prolong the recovery time or result in adverse cardiac events.

关 键 词：右美托咪定 苏醒期躁动 小儿麻醉 

分 类 号：R726.1[医药卫生—儿科] R614[医药卫生—临床医学]