不同剂量的右美托咪定在全麻儿童全口龋齿治疗中的应用  

Application of different doses of dexmedetomidine in the treatment of complex caries in children under general anesthesia

作　　者：王旭[1] 方舒东[1] Wang Xu;Fang Shudong(Department of Anesthesiology, The Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine,Shanghai 200011)

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科

出　　处：《口腔材料器械杂志》2019年第2期22-26,共5页Chinese Journal of Dental Materials and Devices

摘　　要：目的观察不同剂量的右美托咪定用于全麻下儿童全口龋齿治疗中的效果。方法将120例在全麻下行全口龋齿治疗的儿童随机分为3组,对照组C组,低剂量右美托咪定组(L组)和高剂量右美托咪定组(H组),每组40例。静脉给予咪唑安定1mg,芬太尼1.5μg/kg,丙泊酚2mg/kg,罗库溴铵0.6mg/kg,气管插管,吸入1~2%七氟烷,静脉泵入丙泊酚5~8mg/(kg·h)和不同负荷剂量右美托咪定(10min内滴完)并维持。C组,生理盐水;L组右美托咪定0.5μg/kg并以0.2μg/(kg·h)维持,H组右美托咪定1μg/kg并以0.4μg/(kg·h)维持。记录诱导前(T1)、插管后(T2)、插管后15min(T3)、术后拔管时(T4)的收缩压和心率。记录拔管时间以及在苏醒期间的PAEDs评分。记录患儿入手术室、术后15min、术后30min的Ramsay评分。采用GraphPadPrism5软件包进行统计学分析。结果L组和H组在T3、T4时间点的血压和心率均低于C组,且差异有统计学意义(P<0.05)。术后拔管时间L组和C组间无明显差异,但H组术后拔管时间明显延长。和C组比较,H组和L组PAEDs评分均有显著性差异。术后Ramsay评分有显著性差异:术后30minL组的均值接近2,H组到45min才接近2。结论右美托咪定用于儿童全口龋齿全麻治疗安全性良好,能提高苏醒质量,建议采用右美托咪定负荷剂量0.5μg/kg,以0.2μg/(kg·h)维持。Objective To observe the effect of different doses of dexmedetomidine on the treatment of complex dental caries in children under general anesthesia. Methods 120 children with complex dental caries under general anesthesia were randomly divided into three groups: control group C, low dose dextromidine group (L group) and high dose dexmetomidine group (H group) with 40 cases in each group. The children in the experimental group received intravenously midazolam 1 mg, fentanyl 1.5 μg/kg, propofol 2 mg/kg, rocuronium 0.6 mg/kg, after tracheal intubation, they inhalted 1~2% sevoflurane, received intravenously propofol 5-8 mg/kg and different doses of dexmedetomidine, Group C, normal saline;group L, dexmedetomidine 0.5 μg/kg loading dose within 10 min and then kept at 0.2 μg/(kg · h), group H, dexmedetomidine 1 μg/kg loading dose within 10 min then kept at 0.4 μg/(kg · h). The extubation time and PAEDs score during recovery were recorded. Ramsay score was recorded before drugs injected,30 minutes and 45 minutes after operation. GraphPad Prism5 software package was used for statistical analysis. Results The blood pressure and heart rate of group L and group H were lower than those of C group at T3 and T4 time points, and there was significant difference. There was no significant difference in extubation time between group L and group C, but it was significantly longer in group H. Compared with group C, there were significant differences in PAEDs scores between group H and group L. There was significant difference in Ramsay score after operation. 15 min after the operation, the mean value of Ramsay score in group L was close to 2, and which in group H hadn't closed to 2 until 30 min after the operation. Conclusion It is suggested that dexmedetomidine should be used with 0.5 μg/kg loading dose and then kept at 0.2 μg/(kg · h) in the treatment of complex dental caries in children.

关 键 词：右美托咪定 儿童 龋齿 全身麻醉 

分 类 号：R788.1[医药卫生—口腔医学]