右美托咪定持续输注对小儿全麻术后躁动的影响

目的探讨在小儿全麻手术中使用右美托咪定（dexmedetomidine，Dex）持续输注对术后躁动的影响。方法选取美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级、72名4岁．10岁在全麻下行骨折切开复位内固定手术的患儿，采用完全随机分组法随机分为4组（每组18例），分别采用丙泊酚复合Dex（0．5μg·kg-1·h-1）（PD组）及七氟醚复合Dex（SD组），丙泊酚复合生理盐水（PN组）及七氟醚复合生理盐水（SN组）。分别记录患儿泵注Dex前（T1）、泵注后10（T2）、20（T3）、30min（T4）及拔管时（L）的心率（heartrate，HR）、平均动脉压（mean artery pressure，MAP）、脑电双频指数（bispectralindex，BIS）；测定停止麻醉药物至拔管时间、睁眼时间；对术后患儿躁动及疼痛程度进行评分；计算患儿苏醒期躁动的发生率。结果①PD组与PN组比较、SD组与SN组比较，拔管时间[（7．1±2．6）min vs（4．4±2．1）min、（7．3±2．1）minvs（4．9±2．0）mini及睁眼时间[（16±6）minvs（10±3）min、（13±6）min vs（9±5）min]显著延长（P〈O．05），但PD组与SD组比较差异无统计学意义（P〉0．05）。②PD组与PN组、SD组与SN组比较，术后躁动评分（1分vs2分、3分vs4分）及术后患儿疼痛程度评分（cHIPPS评分）（2_5分VS3分、4分vs7分）下降（P〈0．01）。SD组术后躁动发生率显著下降[SD组（5．6％）vsSN组（33．3％）]（P〈0．05）。PD组的躁动评分低于sD组（P〈0．05）。结论Dex虽会造成术后苏醒时间延长，但可以降低小儿麻醉术后躁动评分及术后即刻疼痛评分，并且显著降低七氟醚麻醉术后躁动发生率，使患儿苏醒期更加平稳。

The influence of continuous infusion of dexmedetomidine on pediatric postoperative emergence agitation

Objective To observe the influence of continuous infusion of dexmedetomidine （Dex） on pediatric postoperative emergence agitation. Methods Seventy two patients,ASA I -II, aged 4 y-10 y, scheduled for orthopedic surgery under general, were randomly allocated to four groups. Group PD received propofol and Dex （0.5 μg·kg-1·h-1）, group PN received propofol and sodium chloride, group SD received sevoflurane and Dex, and group SN received sevoflurane and sodium chloride, heart rate（HR）, mean artery pressure（MAP）,bispectral index（BIS） were recorded before drug delivery（%）,10 （T2）, 20 （T3）, 30 min （T4） after administration and after extubation（Ts）, tme from stopping narcotic drugs to extubation（T6） and opening eyes （TT）were determinated. The postoperative agitation and pain score were also measured. The incidence rate of agitation in recovery period was also calculated. Results ① The extubafion tirne[（7.1±2.6） min vs （4.4±2.1） min,（7.3±2.1） min vs （4.9±2.0） mini and opening eyes lime[（16±6） min vs （10±3） min, （13±6） rain vs （9±5） mini were both prolonged significantly when group PD compared with group PN and group SD compared with group SN（P〈0.05 ）. There is no significant difference between group PD and group SD（P〉0.05 ）. ② The postoperative agitation score （1 vs 2,3 vs 4） and pain score （CHIPPS, 2.5 vs 3,4 vs 7） were also decreased in group PD and group SD compared with group PN and group SN, respectively（P〈0.01 ）. The incidence rate of postoperative agitation was decreased significantly in group SD（group SD 5.6% vs group SN 33.3%）（P〈0.05）. The emergence agitation score of group PD was lower than of group SD（P〈0.05）. Conclusions Although Dex may prolong the palinesthesia, it can decrease the postoperative agitation and pain.