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目的观察小剂量右美托咪定在小儿气管插管静吸复合全身麻醉中的作用,为麻醉安全用药提供依据。方法 2011年1月至7月在武汉市妇女儿童医疗保健中心住院拟行鼾症根治术和眼睑内翻矫治术的患儿纳入研究,随机分为3组:A组(诱导麻醉开始时予右美托咪定0.5μg/kg),B组(诱导麻醉开始时予右美托咪定1.0μg/kg)及C组(不予右美托咪定)。3组患儿均采用气管插管静吸复合全身麻醉方法,观察并记录不同时点患儿心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PetCO2)、潮气量和呼吸频率,进行镇静程度评分,记录各组呼吸抑制及躁动发生率。结果共120例年龄4～11岁患儿纳入研究,其中男80例,女40例。A、B、C组各40例。3组患儿一般情况及手术时间差异均无统计学意义(均P>0.05)。3组患儿在不同时点的SpO2、PetCO2、潮气量与呼吸频率的差异均无统计学意义(均P>0.05)。术后A、B、C组患儿中分别有1例(2.5%)、2例(5.0%)、5例(12.5%)出现呼吸抑制,经面罩加压给氧后均缓解。A、B组患儿应用右美托咪定后均出现心率下降和MAP升高,但均在正常范围内,均能自行或给予阿托品后恢复至基础值。A、B组患儿术后躁动发生率分别为5.0%(2/40)和2.5%(1/40),明显低于C组(22.5%,9/40,P<0.05)。B组患儿镇静过度发生率(12.5%,5/40)高于A组(2.5%,1/40,P<0.05)。结论小儿气管插管全麻诱导麻醉时静脉输注小剂量右美托咪定(0.5μg/kg)可有效预防患儿术后呼吸抑制及躁动的发生,安全有效。
Objective To observe the effect of low-dose dexmedetomidine in general anesthesia of tracheal intubation and inhalation anesthesia in anesthesia to provide the basis for safe anesthesia. Methods From January to July 2011, children who were hospitalized for snoring and cuff surgery in Wuhan Women and Children’s Medical Center were enrolled and randomly divided into three groups: group A (right after induction of anesthesia Me trilimidine 0.5 μg / kg), group B (dexmedetomidine 1.0 μg / kg when induction of anesthesia was induced) and group C (dexmedetomidine was not used). The tracheal intubation and inhalation combined with general anesthesia was used to observe the changes of heart rate, mean arterial pressure (MAP), pulse oxygen saturation (SpO2), end-tidal carbon dioxide partial pressure (PetCO2 ), Tidal volume and respiratory rate, the severity of sedation score was recorded in each group respiratory depression and agitation rate. A total of 120 cases of children aged 4 to 11 years were included in the study, 80 were male and 40 were female. A, B, C group of 40 cases. There was no significant difference in the general situation and operation time between the three groups (all P> 0.05). There were no significant differences in SpO2, PetCO2, tidal volume and respiratory rate between the three groups at different time points (all P> 0.05). One patient (2.5%), two patients (5.0%) and five patients (12.5%) in group A, B and C had respiration inhibition. In group A and group B, both dexmedetomidine and dexmedetomidine decreased heart rate and MAP, but all of them were within the normal range and were able to recover to basal value after taking atropine or self. The incidence of postoperative agitation in group A and group B was 5.0% (2/40) and 2.5% (1/40) respectively, which was significantly lower than that in group C (22.5%, 9/40, P <0.05). The incidence of sedation in group B was significantly higher than that in group A (12.5%, 5/40) (2.5%, 1/40, P <0.05). Conclusion Intravenous infusion of low dose dexmedetomidine (0.5 μg / kg) during induction of anesthesia by pediatric endotracheal intubation can effectively prevent postoperative respiratory depression and restlessness in children and is safe and effective.