右美托咪定在小儿脑室-腹腔分流术中的应用

目的观察右美托咪定在小儿脑室-腹腔分流术中对血流动力学、术毕苏醒期躁动的影响以及脑保护作用。方法74例行脑室-腹腔分流术的先天性脑积水患儿,通过随机数表法分为观察组D组(37例)和对照组N组(37例)。观察组先给予1μg/kg的右美托咪定负荷量静脉泵入后再以0.5μg/(kg·h)速度维持给药,对照组使用同容量的生理盐水。比较2组术中MAP和HR的变化,比较2组拔管时间和苏醒时间,测定不同时间点血清中S100β蛋白和神经元特异性烯醇化酶(NSE)的浓度,根据Ramsay评分和FLACC评分评价患儿术后躁动和镇痛情况。结果 D组术中、术后MAP和HR变化均小于对照组N组(P0.05);2组拔管时间、苏醒时间无明显差异(P0.05));N组NSE和S100β蛋白浓度在术后各时间点均高于D组(P0.05);D组Ramsay评分高于N组而FLACC评分低于N组,差异有统计学意义(P0.05)。结论右美托咪定在小儿脑室-腹腔分流术中的应用,可较好地稳定术中患儿的生命体征,减少苏醒期躁动,提高苏醒质量,且有一定的脑保护作用。

Application of dexmedetomidine in pediatric ventricle peritoneal shunt

Objective To observe the effects of dexmedetomidine for hemodynamics,emergence agitation during ventricle peritoneal shunt (VPS),and its investigate neuroprotective effects.Methods Totally 74 cases of hydrocephalus in children treated by VPS were divided into the observation group (D group,37 cases) and the control group (N group,37 cases) according to the random number method.The loading dose of dexmedetomidine in D group was 1μg/kg and the maintenance dose was 0.5μg/(kg·h),and the N group received the same amount of saline,mean arterial pressure (MAP) and heart rate (HR) changes between the two groups were compared,extubation time and recovering time between the two groups were compared.Human soluble protein-100β (S100β) and neurone specific enolase (NSE) were measured at different time points respectively,evaluation of postoperative irritability and pain by Ramsay score and FLACC score.Results The MAP and HR of the D group at each time had smaller change compared with those of the N group (P<0.05).There were no differences on the extubation time and recovering time between two groups (P>0.05).NSE and S100β in N group at various time points were higher than those in D group (P<0.05).In the D group,Ramsay score was higher than N group and FLACC score was lower than N group (P<0.05).Conclusion The application of dexmedetomidine in VPS has better hemodynamic stability effect and can effectively reduce emergence agitation in children,enhance the recovery quality,and play a role in brain protection.