右美托咪定在儿童扁桃体手术围拔管期的应用

目的观察右美托咪定在小儿扁桃体、腺样体切除手术术后围拔管期的镇静作用。方法选择择期进行扁桃体、腺样体切除手术的患儿60例，随机分为常规组（A组）和右美托咪定组（B组）各30例；两组均以丙泊酚和瑞芬太尼靶控输注诱导及维持，手术结束时停药，并静注曲马多2mg／kg。B组手术结束前10min静脉注射右美托咪定0．5μg／kg，输注时间10min。两组均等待患儿自然清醒拔管，观察两组生命体征变化、术后睁眼时间、拔管时间以及苏醒期躁动、上呼吸道梗阻、术后恶心呕吐等情况。结果B组拔管时和术后清醒时平均动脉压（MAP）和心率（HR）较A组低，差异有统计学意义（P〈0．05）；B组睁眼时间和拔管时间长于A组，差异有统计学意义（P〈0．05）；A、B组术后上呼吸道梗阻率分别为6．7％和10．O％，术后恶心呕吐发生率为16．7％和13．3％，差异均无统计学意义：B组苏醒期躁动发生率为10．0％，较A组的30．0％低．差异有统计学意义（P〈0．05）。结论右美托咪定在手术围拔管期的应用能较好地用于儿童扁桃体手术术后拔管期的镇静，稳定患儿循环情况，减少苏醒期躁动的发生。

The clinical use of Dexmedetomidine during extubation period on pediatric tonsillectomy

Objective To observe the analgesia and sedative effects of Dexmedetomidine after pediatric tonsillectomy and adenoidectomy during the extubation period of general anesthesia. Methods 60 patients undergoing the general anesthesia were selected, and divided into two groups randomly： group A （general sedation group, n=30）, group B （dexmedetomidine group,n=30）. Two groups were induced and maintained with Propofol and Remifentanil by target- controlled infusion （TCI） and 2 mg/kg Tramadol was administrated introvenously after surgery. 0.5 μg/kg Dexmedetomidine was administrated in addition in group B within 10 minutes. The hemodynamics during the extubation period, vital signs, waking time, extubation time, dysphoria, upper respiratory tract obstruction and vomiting were observed. Results There were obviously lower on MAP and HR in the group B than in group A during the extubation period and awaken period （P〈0.05）. Group B was significant different from A on the waking time and extubation time （P〈 0.05）,and there were no significant difference（P〉0.05） between two groups about upper respiratory tract obstruction rate and postoperative nausea and vomiting rate. The dysphoria rate of Group B was 10.0% which was significantly lower than Group A＇s 30%（P〈0.05）. Conclusion Dexmedetomidine can prevent the reaction during the extubation period on the pediatric tonsillectomy and adenoidectomy, and make the general anesthesia to be safe and better recovery.