右美托咪定复合盐酸纳美芬用于阑尾切除术患儿喉罩麻醉对复苏质量及应激指标的影响

目的 探讨右美托咪定（dexmedetomidine，DEX）复合盐酸纳美芬用于阑尾切除术患儿喉罩麻醉对复苏质量及应激指标的影响。 方法 选取我院行阑尾切除术的患儿98例，采用DEX复合盐酸纳美芬喉罩麻醉的42例患儿纳入复合组，采用喉罩麻醉的56例患儿纳入对照组，比较两组手术情况、术中应激反应、术后复苏质量、精神状态及并发症情况。 结果 复合组患儿清醒时间、喉罩拔出时间、自主呼吸时间、下床活动时间、肛门排气时间、住院时间短于对照组（P＜0.05）；术后两组去甲肾上腺素（norepinephrine，NE）、肾上腺素（epinephrine，E）、皮质醇（cortisol，Cor）、促肾上腺皮质激素（adrenocorti-cotrophic hormone，ACTH）水平均较T0明显升高，复合组T2、T3时点的NE、E水平低于对照组，T1时点两组差异无统计学意义（P＞0.05），复合组T1、T2、T3时点发热Cor、ACTH水平低于对照组（P＜0.05）；喉罩拔出后5 min两组Ramsay、FLACC评分差异无统计学意义（P＞0.05）；喉罩拔出后30 min、喉罩拔出后60 min两组Ramsay评分、FLACC评分降低，且复合组Ramsay评分、FLACC评分低于对照组（P＜0.05）；复合组精神状态优于对照组（P＜0.05）；两组术后并发症发生率差异无统计学意义（P＞0.05）。 结论 DEX复合盐酸纳美芬用于阑尾切除术患儿喉罩麻醉有助于缩短麻醉复苏时间，降低患儿的应激反应，提高患儿术后复苏质量，缓解患儿术后疼痛，安全可靠。

Effect of dexmedetomidine combined with nalmefene hydrochloride in laryngeal mask anesthesia on the quality of resuscitation and stress indicators in children undergoing appendectomy

Objective To investigate the effect of dexmedetomidine(DEX) combined with nalmefene hydrochloride in laryngeal mask anesthesia on the quality of resuscitation and stress indicators in children undergoing appendectomy.Methods A total of 98 children who underwent appendectomy in our hospital were selected. Of them, 42 children who received DEX combined with nalmefene hydrochloride for laryngeal mask anesthesia were included in the combination group, and 56 children who underwent laryngeal mask anesthesia were included in the control group. The operative conditions, intraoperative stress response, postoperative resuscitation quality, mental status and complications were compared between two groups.Results The awake time, laryngeal mask removal time, spontaneous breathing time, time of off-bed activity, anal exhaust time, and length of hospital stay in the combination group were significantly shorter than those in the control group(P＜0.05). Norepinephrine(NE), adrenaline(E), cortisol(Cor), and adrenocorticotropic hormone(ACTH) levels in two groups after surgery were significantly higher than those at T0, while the NE and E levels at T2 and T3 in the combination group were significantly lower than those in the control group at T1, suggesting no significant difference between the two groups(P＞0.05). The levels of fever Cor and ACTH at T1, T2, and T3 in the combination group were significantly lower than those in the control group(P＜0.05). There was no significant difference in Ramsay and FLACC scores between two groups of children at 5 min after the mask removal(P＞0.05). The Ramsay and FLACC scores of the two groups were significantly reduced at 30 min and 60 min after the mask removal, and the Ramsay score and FLACC score of the combination group were significantly lower than those of the control group(P＜0.05). The mental state of children in the combination group was significantly better than that of the control group(P＜0.05); The incidence of postoperative complications in two groups was not significantly different(P＞0.05).Conclusion DEX combined with nalmefene hydrochloride for laryngeal mask anesthesia in children undergoing appendectomy can help shorten the anesthesia recovery time, reduce the children′s stress response, improve the quality of postoperative recovery, and ease the postoperative pain, with good safety and reliability.