不同剂量右美托咪定对小儿短小手术氯胺酮麻醉后躁动的影响

目的 探讨不同剂量右美托咪定对小儿短小手术氯胺酮麻醉后躁动影响。 方法 选择2017年1—6月于中南大学湘雅二医院麻醉科使用氯胺酮进行麻醉并行短小手术患儿90例，按照随机数字表法将其均分为A、B、C 3组，每组30例。患儿手术开始时均按照1 mg/kg的剂量静注氯胺酮，而后A组采用右美托咪定0.2 μg/(kg·h)的速率进行静脉维持麻醉，B组采用0.4 μg/(kg·h)的速率进行麻醉，C组按照0.8 μg/(kg·h)的速率进行麻醉。比较患儿苏醒时间、拔管时间，患儿手术结束苏醒后使用Malviya评分法对患儿躁动出现率进行评估，使用Ramasy镇静程度评分对术后患儿情况进行评估，最后使用视觉模拟量表(VAS)对患儿术后1、2 h的疼痛度进行评估。 结果 A组的唤醒时间及拔管时间最短，其次B组，时间最长的是C组，差异具有统计学意义(均P<0.05)；A组躁动率高于B和C组，C组高于B组，差异具有统计学意义(均P<0.05)；A组患儿Ramasy镇静程度评分为(1.32±0.21)分，B组为(3.14±0.51)分，C组为(4.22±0.61)分，差异具有统计学意义(P<0.05)，其中C组高于A和B组，B组高于A组(均P<0.05)；术后1、2 h时A组VAS评分最高，其次是B组，C组VAS得分最低，差异具有统计学意义(均P<0.05)。 结论 使用小剂量氯胺酮麻醉后行短小手术的小儿加用0.4 μg/(kg·h)的右美托咪定有利于缩短患儿术后苏醒及拔管时间，降低其术后躁动出现率和疼痛度，同时减少术后嗜睡等后遗症的出现率，效果较为明显。 

Effects of different doses of dexmedetomidine on agitation after ketamine anesthesia in children

Objective To investigate the effects of different doses of dexmedetomidine on restlessness after ketamine anesthesia in children undergoing short-term surgery. Methods From January 2017 to June 2017, 90 pediatric patients aged 11-15 years who underwent ketamine anesthesia and minor surgery in the Department of Pediatrics, Xiangya Second Hospital of Central South University were divided into group A, B and C according to the random number table method. Thirty patients in each group were given ketamine intravenously at a dose of 1 mg/kg at the beginning of operation, and then group A received intravenous maintenance anesthesia at a rate of 0.2 μg/(kg·h) of dexmedetomidine. Group B was anesthetized at a rate of 0.4 μg/(kg·h). Group C was anesthetized at a rate of 0.8 μg/(kg·h). The patients had the same operation mode. The recovery time and extubation time of the children were compared. Malviya score was used to evaluate the incidence of restlessness after the operation, Ramasy sedation score was used to evaluate the condition of the children after the operation, and finally vision was used. The analogue scale (VAS) was used to evaluate the pain level of children 1 and 2 hours after operation. Results The shortest wake-up time and extubation time were found in group A, followed by group B, and the longest was in group C, with statistical significance (all P<0.05); the restlessness rate in group A was higher than that in group B and C, and that in group C was higher than that in group B, with statistical significance (all P<0.05); Ramasy sedation score in group A was (1.32±0.21), group B was (3.14±0.51), and group C was (4.22±0.61). Significance (P<0.05), in which group C was higher than group A and B, and group B was higher than group A (all P<0.05); VAS score of group A was the highest at 1 h and 2 h after operation, followed by group B, and VAS score of group C was the lowest, with statistical significance (all P<0.05). Conclusion The use of 0.4 μg/(kg·h) dexmedetomidine in children undergoing minor surgery after anesthesia with low dose ketamine can shorten the recovery time and extubation time, reduce the occurrence rate of restlessness and pain, and reduce the occurrence rate of sequelae such as sleepiness after surgery.