右美托咪定对机器人辅助腹腔镜下婴儿肾盂成形术局部脑氧饱和度的影响  

Effect of dexmedetomidine on regional cerebral oxygen saturation in infants undergoing robot-assisted laparoscopic pyeloplasty

作　　者：卢彦 王乙茹 郭文治[1] 杨白雪 马丽[1] Lu Yan;Wang Yiru;Guo Wenzhi;Yang Baixue;Ma Li(Department of Anesthesiology,the Seventh Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心麻醉科,北京100700

出　　处：《发育医学电子杂志》2024年第6期438-444,共7页Journal of Developmental Medicine (Electronic Version)

基　　金：住院医师规范化培训质量提高项目(科教处2022jy022)。

摘　　要：目的观察右美托咪定(dexmedetomidine,DEX)对婴儿行机器人辅助腹腔镜下肾盂成形术(robot-assisted laparoscopic pyeloplasty,RALP)时的局部脑氧饱和度(regional cerebral oxygen saturation,rScO_(2))的影响。方法采用前瞻性研究方法,选取2021年5月至2023年5月于解放军总医院第七医学中心行RALP的90例患儿(<1岁)为研究对象,采用随机数字表法将其分为研究组和对照组,每组45例。2组患儿使用相同的麻醉诱导方法,研究组在气管插管完成后静脉输注DEX,先给予负荷剂量1μg/kg,10 min内输注完成,而后以0.4μg/(kg·h)静脉泵输注,手术完成前0.5 h停药;对照组给予等容量0.9%氯化钠溶液。比较2组患儿各时间点的rScO_(2)、氧分压、二氧化碳分析、血压、心率、动脉血乳酸水平,以及苏醒期谵妄发生率、术后第3天及第5天C反应蛋白水平、术后不良反应的差异。统计学方法采用t检验、秩和检验、重复测量方差分析、χ^(2)检验和非参数检验。结果2组各时间点rScO_(2)组间比较,差异无统计学意义(P>0.05)。2组各时间点的氧分压、二氧化碳分压、收缩压、舒张压比较,差异均无统计学意义(P值均>0.05)。研究组气腹后1 h及2 h动脉血乳酸水平低于对照组[(0.69±0.20)mmol/L与(0.93±0.32)mmol/L,(0.75±0.21)mmol/L与(1.16±0.53)mmol/L],差异均有统计学意义(t=4.151,P<0.001;t=4.842,P<0.001)。T5时,研究组患儿心率低于对照组,差异有统计学意义(P<0.05)。研究组苏醒期谵妄发生率低于对照组[15.6%(7/45)与42.2%(19/45)],差异有统计学意义(χ^(2)=7.788,P=0.005)。研究组术后第3天及术后第5天的C反应蛋白水平低于对照组[(17.1±12.0)mg/L与(18.3±8.8)mg/L,(9.2±3.5)mg/L与(10.6±5.7)mg/L],差异均有统计学意义(t=-3.404,P=0.001;t=-3.121,P=0.002)。2组患儿术后不良反应发生率比较,差异无统计学意义(P>0.05)。结论DEX持续泵注对婴儿行RALP时的rScO_(2)影响不明显,但降低了患儿麻醉苏醒期谵妄�Objective To observe the influences of dexmedetomidine(DEX)on regional cerebral oxygen saturation(rScO_(2))in infants undergoing robot-assisted laparoscopic pyeloplasty(RALP).Method Used a prospective research method,a total of 90 infants(<1 year)who underwent RALP in the Seventh Medical Center of PLA General Hospital,from May 2021 to May 2023 were selected,and were divided into study group and control group by random number table method,with 45 cases in each group.The anesthesia induction protocol was the same for both groups.After endotracheal intubation was finished,DEX(1μg/kg)was infused intravenously for 10 min as loading dose in the study group,followed by the dose of 0.4μg/(kg·h)with an intravenous pump until 0.5 h before the surgery finished.Patients in the control group were given an equal volume of saline.rScO_(2),oxygen partial pressure,carbon dioxide analysis,blood pressure,heart rate,arterial blood lactic acid level,incidence of emergence delirium,C-reactive protein level on the 3rd and 5th day after surgery,and postoperative adverse reactions were compared between the two groups at each time point.The statistical methods performed by t-test,rank sum test,repeated measures ANOVA,χ^(2) test and nonparametric test.Result There was no significant difference in rScO_(2) between the two groups at each time point(P>0.05).There were no significant differences in oxygen partial pressure,carbon dioxide partial pressure,systolic blood pressure,diastolic blood pressure between the two groups at each time point(all P>0.05).The blood lactic acid level of the study group was lower than that of the control group at 1 h and 2 h after pneumoperitoneum[(0.69±0.20)mmol/L vs(0.93±0.32)mmol/L,(0.75±0.21)mmol/L vs(1.16±0.53)mmol/L],and the differences were statistically significant(t=4.151,P<0.001;t=4.842,P<0.001).At T5,the heart rate of the study group was lower than that of the control group,and the difference was statistically significant(P<0.05).The incidence of delirium during recovery in the study group was

关 键 词：右美托咪定 机器人手术 腹腔镜 肾盂成形术 婴儿 局部脑氧饱和度 

分 类 号：R726.1[医药卫生—儿科]