右美托咪定联合地佐辛在小儿扁桃体和腺样体摘除术中的应用价值  

Application of Dexmedetomidine Combined with Dezocine in Children Tonsillectomy and Adenoidectomy

作　　者：朱炜[1] 杨明镜[2] 江培颜[1] ZHU Wei;YANG Mingjing;JIANG Peiyan(Department of Anesthesiology,Macheng People′s Hospital,Macheng 438300,China;Department of Anesthesiology,the Second Hospital of Jingzhou,Jingzhou 434000,China)

机构地区：[1]麻城市人民医院麻醉科,湖北麻城438300 [2]荆州市第二人民医院麻醉科,湖北荆州434000

出　　处：《医学综述》2019年第1期202-207,共6页Medical Recapitulate

摘　　要：目的探讨右美托咪定联合地佐辛在小儿扁桃体和腺样体摘除术中的应用价值。方法选取2015年5月至2017年6月在麻城市人民医院住院接受扁桃体和腺样体摘除术治疗的88例患儿,根据随机数字法分为研究组和对照组,各44例。麻醉诱导前先给予研究组1μg/kg负荷量泵注4μg/m L浓度的右美托咪定,输注时间为10 min,后以0. 5μg/(kg·h)剂量进行持续泵注50 min;对照组麻醉诱导前使用与研究组右美托咪定等体积的0. 9%Na Cl注射液,后同时给予对照组与研究组0. 01 mg/kg盐酸戊乙奎醚+2~3μg/kg芬太尼+0. 15 mg/kg顺阿曲库铵+2~2. 5 mg/kg丙泊酚等药物静滴进行麻醉诱导。术毕分别给予研究组和对照组0. 1 mg/kg地佐辛静脉滴注。比较两组围术期各时点[入室5 min(T_0)、插管时(T_1)、插管后10 min(T_2)、拔管时(T_3)、拔管后15 min(T_4)]血流动力学指标变化情况,并对比两组患者术后4 h、6 h、24 h时的躁动情况、镇静情况、疼痛程度;同时记录并比较两组不良反应发生情况。结果两组患儿T1时点,舒张压、收缩压、平均动脉压水平较T0时点均呈下降趋势,且研究组降低速度更缓,而T_2、T_3、T_4时点各水平较T0时点均呈升高趋势,且研究组更接近T0时点水平,两组在组间、时点间、组间·时点间交互作用比较差异均有统计学意义(P <0. 01);两组术后4 h、6 h、24 h时儿童麻醉后躁动评分、Ramsay镇静评分、东安大略儿童医院疼痛评分均呈下降趋势,且研究组下降速度更快,两组在组间、时点间、组间·时点间交互作用比较差异均有统计学意义(P <0. 01);研究组术后恶心呕吐、嗜睡、低氧血症等发生率与对照组比较差异无统计学意义(P> 0. 05);研究组术后心动过速发生率明显低于对照组(P <0. 05)。结论接受扁桃体和腺样体摘除术的患儿术中联合使用右美托咪定与地佐辛有利于提高手术实施安全性,患儿围术期血流动力学稳定Objective To investigate the application value of dexmedetomidine combined with dezocine in children tonsillectomy and adenoidectomy.Methods A total of 88 children who received tonsillectomy and adenoidectomy in Macheng People′s Hospital from May 2015 to Jun.2017 were included in the study,and they were divided into a research group and a control group by random number method,with 44 cases in each group.Before anesthesia induction,the research group was pumped 4μg/mL dexmedetomidine at the rate of 1μg/kg,for 10 min,then pumped dexmedetomidine at the rate of 0.5μg/(kg·h)for about 50 min continuously.The control group was administered with the equal volume of 0.9%NaCl injection of dexmedetomidine before the anesthesia induction.Then the control group and research group were given intravenous drip with 0.01 mg/kg penehyclidine hydrochloride+2-3μg/kg fentanyl+0.15 mg/kg cisatracurium+2-2.5 mg/kg propofol for anesthesia induction.After surgery,the research group and control group were given intravenous drip of 0.1 mg/kg dezocine respectively.The changes of perioperative hemodynamic indexes at different time points[5 min after entering operating room(T 0),at intubation(T 1),after intubation for 10 min(T 2),at extubation(T 3),15 min after extubation(T 4)]of the two groups were compared.The postoperative 4 h,6 h,24 h agitation,sedation,pain degree and adverse reactions were compared between the two groups.Results The levels of diastolic pressure,systolic pressure,mean arterial pressure in the two groups at T 1 showed decreasing trend compared with those at T 0,the decreasing speed of research group was slower,while the levels at T 2,T 3,T 4 showed increasing trend compared with those at T 0,the research group was closer to the levels at T 0,and the differences between groups,time points,group·time point interaction were statistically significant(P<0.01);the postoperative 4 h,6 h,24 h pediatric anesthesia emergence delirium score,Ramsay sedation score,Children′s Hospital of Eastern Ontario Pain Scale in the two

关 键 词：扁桃体 腺样体摘除术 右美托咪定 地佐辛 术后躁动 

分 类 号：R726.1[医药卫生—儿科]