右美托咪定平均有效剂量及95%有效剂量的测定对预防学龄前期儿童麻醉苏醒期躁动的意义  

Determination of the median effective dose of dexmedetomidine for the prevention of agitation during anesthesia recovery in pre-school children

作　　者：汪卫兵[1] 孙爱娇[1] 徐煌[1] 余红平 肖敬波[1] WANG Weibing;SUN Aijiao;XU Huang;YU Hongping;XIAO Jingbo(Department of Anesthesiology,Anqing Municipal Hospital,Anqing,Anhui 246003,China)

机构地区：[1]安庆市立医院麻醉科,安徽安庆246003

出　　处：《安徽医药》2022年第5期1034-1038,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨右美托咪定平均有效剂量(ED50)及95%有效剂量(ED95)测定对预防学龄前期儿童行扁桃体和(或)腺样体切除术麻醉苏醒期躁动的意义。方法选取2019年8―12月安庆市立医院拟在全身麻醉下行扁桃体和(或)腺样体切除术的学龄前期病儿60例,均为美国麻醉医师协会(ASA)Ⅰ~Ⅱ级,第一例病儿完成气管插管后,采用右美托咪定0.6μg·kg^(-1)·h^(-1)持续静脉输注,直到手术结束停止输注。根据Dixon序贯法,若病儿发生苏醒期躁动则为无效剂量,则下一例病儿采用高一级剂量,若病儿未发生苏醒期躁动则为有效剂量,则下一例病儿采用低一级剂量,相邻剂量相差0.05μg。儿童苏醒期躁动采用儿童术后躁动评分量表(PAED),PAED≥12分定义为麻醉苏醒期躁动。结果根据Dixon-Massey公式计算,右美托咪定用于预防学龄前期儿童苏醒期躁动的ED50为0.41μg·kg^(-1)·h^(-1)(95%CI:0.38~0.44),利用Probit回归预测其ED95为0.57μg·kg^(-1)·h^(-1)(95%CI:0.52~0.70)。所有病儿未发生镇静时间延长、呼吸抑制及拔管时间延迟等并发症,心动过缓是主要并发症。结论对于预防学龄前期儿童苏醒期躁动,合适的右美托咪定剂量非常重要。ED50和ED95测定能有效预防学龄前期儿童苏醒期躁动,而且未出现类似成人的并发症。Objective To determine the median effective dose(ED50)and 95%effective dose(ED95)of dexmedetomidine in prevention of the emergence agitation for pre-school children undergoing tonsillectomy and/or adenoidectomy with general anesthesia.Methods A total of 60 pre-school children(ASAⅠtoⅡ)scheduled for tonsillectomy and(or)adenoidectomy under general anesthesia in Anqing Municipal Hospital from August to December 2019 were enrolled.After the first children underwent tracheal intubation,dexmedetomidine 0.6μg·kg^(-1)·h^(-1) intravenous continuous infusion,and the infusion was stopped until end of the surgery.According to the Dixon up-and-down method,if the patient had resuscitation agitation,it was an invalid dose,and the next patient was given a higher first-order dose;if the patient did not have resuscitation agitation,it was an effective dose,and the next patient was given a lower first-order dose with a difference of 0.05μg between adjacent doses.Children's Postoperative Agitation Rating Scale(PAED)was used in Children's agitation during emergence from anesthesia,PAED≥12 points was defined as agitation during recovery from anesthesia.Results The ED50 of dexmedetomidine in prevention of the emergence agitation for pre-school children undergoing tonsillectomy was calculated by Dixon-Massey formula was 0.41μg·kg^(-1)·h^(-1)(95%CI:0.38-0.44),and ED95 was calculated by Probit regression analysis was 0.57μg·kg^(-1)·h^(-1)(95%CI:0.52-0.70).Conclusion Dexmedetomidine can effectively prevent agitation during recovery period for pre-school children undergoing tonsillectomy and/or adenoidectomy,bradycardia is the main complication in perioperative period.

关 键 词：右美托咪定 平均有效量 扁桃体切除术 全身麻醉 儿童 学龄前 

分 类 号：R726.1[医药卫生—儿科]