右美托咪定对腺样体切除小儿患者苏醒期间的影响

目的:观察右美托咪定对小儿腺样体切除术后苏醒期间疼痛和躁动的影响。方法:选择择期行腺样体切除术,年龄4~12岁,ASA分级Ⅰ~Ⅱ级小儿患者88例。随机分为对照组(C组)和右美托咪定组(D组),每组44例。两组均采用8%七氟烷进行吸入麻醉诱导,C组诱导期间静脉给予芬尼2μg/kg,而D组则缓慢静注右美托咪定1μg/kg(给药时间大于10 min)随后0.5μg.kg-1.h泵注维持,手术结束前10 min停止。两组心率或收缩压较切皮前上升30%且持续3 min以上时静注1μg/kg。记录术中相关数据,在患者进入麻醉恢复时(0 min)、入室后5、10 min、15 min,以后每隔15 min测定疼痛评分、苏醒期躁动评分;疼痛评分大于4分或严重躁动持续3 min以上给予芬太尼0.5μg/kg。结果:两组术中均未使用阿托品和麻黄素控制心率和血压,D组术中心率较C组对应时间点低而收缩压比较无明显差别。D组患者睁眼时间和拔管时间明显短于C组(P<0.05,P<0.01);D组术中和复苏室追加芬太尼剂量分别为(22±8)μg和(15±7)g,与C组比较有统计学差异(P<0.05)。拔管后苏醒期间低氧发生率D组(5%)低于C组(12%),严重躁动发生率(观察时间为15 min内)D组(27%)显著低于C组(54%),两组比较有统计学差异(P<0.01)。D组在0、5和15 min重度疼痛评分比例较C组低(P<0.01)。结论:小儿患者腺样体切除术右美托咪定1μg/kg负荷剂量,随后0.5μg.kg-1.h泵注可以降低术后躁动的发生,减轻疼痛,降低镇痛药物(芬太尼)用量,减少麻醉恢复期间呼吸抑制的发生。

Effects of dexmedetomidine on severity of emergence pain and agitation in children undergoing adenoidectomy

AIM: To observe the effects of dexmedetomidine on severity of emergence pain and agitation in children undergoing adenoidectomy. METHODS: 88 patients scheduled for adenoidectomy,ages 4 to 12 years,were enrolled and randomly allocated into control group(n=44,group C) and dexmedetomidine group(n=44,group D).Group C were received intravenous fentanyl bolus 2 g/kg after anesthesia induction with sevoflurane,whereas in group D were received intravenous dexmedetomidine bolus 1 g/kg over 10 minutes,followed by 0.5...