右美托咪啶及小剂量氯胺酮预防小儿全麻苏醒期躁动的对比观察

目的:观察右美托咪啶及小剂量氯胺酮对小儿腺样体扁桃体切除术苏醒期躁动(EA)的预防效果及安全性,并对二者的预防效果进行对比观察。方法:选择全身麻醉下行腺样体扁桃体切除手术患儿60例随机分为3组,右美托咪啶(D)、小剂量氯胺酮(K)、生理盐水(H)组各20例。麻醉诱导气管插管后,D组泵注右美托咪定1μg/kg(容量为10 ml),K组泵注小剂量氯胺酮0.3 mg/kg(容量为10 ml),H组泵注生理盐水10 ml,3组均在10 min泵注完毕。所有病例均丙泊酚及瑞芬太尼维持麻醉,连续监测血压、心电图、心率、血氧饱和度,观察苏醒时间(停麻醉药至呼唤能睁眼)、复苏室停留时间、术后苏醒期躁动、并发症等情况。结果:患儿术后躁动发生率D组5.0%,K组35.5%,H组80.0%,组间比较差异有统计学意义(P<0.05);与H组相比,D和K组拔管后1～4 h Ramsay镇静评分增高,差异有统计学意义(P<0.05),D组术后呈现平稳睡眠的例数较K和H组相比明显较多。结论:右美托咪啶及小剂量氯胺酮均可预防小儿苏醒期躁动,右美托咪啶效果更佳更安全。

Comparison and observation on infantile dysphoria during revival period in full anesthesia prevented by dexmedetomidine and low-dose ketamine

Objective:To observe the effects and safeties of dexmedetomidine and low-dose ketamine used to prevent dysphoria during revival period in full anesthesia in children undergoing adenotonsillectomy,then the preventive effects of the two drugs were compared and observed.Methods:Sixty children who received adenotonsillectomy under general anesthesia were randomly divided into three groups: dexmedetomidine group(D group),low-dose ketamine group(K group),and normal saline group(H group),20 children in each group.After endotracheal intubation under anesthesia induction,the children in D group were treated with pump infection of dexmedetomidine(1 μg/kg,volume: 10 ml),the children in K group were treated with pump infection of low-dose ketamine(0.3 mg/kg,volume: 10 ml),and the children in H group were treated with pump infection of normal saline(10 ml),the operation was completed within 10 minutes in the three groups.In the three groups,propofol and remifentanil were used to sustain anesthesia;blood pressure,cardiogram,heart rate,and oxyhemoglobin saturation were monitored continuously;the revival time(from stoping anesthetic to opening eyes by a call),duration of stay in resuscitation room,postoperative dysphoria during revival period,and complications were observed.Results:The incidence rates of postoperative dysphoria in D group,K group,and H group were 5.0%,35.5%,and 80.0%,respectively,there was statistically significant difference among the three groups(P<0.05);compared H group,1-4-hour Ramsay score in D group and K group increased significantly(P<0.05),the number of children with smooth sleeping in D group was significantly higher than those in K group and H group.Conclusion:Both dexmedetomidine and low-dose ketamine can prevent infantile dysphoria during revival period,and dexmedetomidine is more effective and safer.