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目的观察右美托咪定对小儿腹腔镜手术中顺式阿曲库铵肌松效应的影响。方法选择2014年1月—2016年1月秦皇岛市第一医院行腹腔镜手术患儿40例,随机分为对照组和治疗组,每组各20例。两组术中静脉输注注射用苯磺顺阿曲库铵,诱导剂量0.1 mg/kg,维持剂量1~2μg/(kg·min~(-1))。治疗组麻醉诱导前20 min滴鼻盐酸右美托咪定注射液,3μg/kg,持续15 min,插管后静脉泵入盐酸右美托咪定注射液,0.5μg/(kg·h-1),持续至手术结束前20 min;对照组用等量生理盐水代替。观察两组肌松效应指标、血流动力学指标、肌松恢复指标和Steward评分情况。结果治疗组肌松起效时间明显短于对照组,两组比较差异具有统计学意义(P<0.05)。在诱导时刻、插管后3 min和拔管后30 min,治疗组平均动脉压(MAP)明显低于诱导前20 min,比较差异有统计学意义(P<0.05);在诱导时刻、插管时刻、拔管时刻和拔管后30 min,治疗组MAP明显低于对照组同期,两组比较差异有统计学意义(P<0.05)。在插管时刻,对照组HR低于诱导前20 min,在拔管后30 min,对照组心率(HR)高于诱导前20 min,比较差异有统计学意义(P<0.05);在诱导时刻、插管时刻和拔管后30min,治疗组HR低于诱导前20 min,比较差异有统计学意义(P<0.05);在诱导时刻、插管时刻、插管后3 min和拔管后30 min,治疗组HR明显低于对照组同期,两组比较差异有统计学意义(P<0.05)。治疗组肌松起效时间明显短于对照组,两组比较差异具有统计学意义(P<0.05),而两组肌松维持时间比较差异无统计学意义。两组肌松恢复指标和Steward评分比较差异无统计学意义。结论右美托咪定可以增强小儿腹腔镜手术中顺式阿曲库铵的肌松效应,但不会延长维持时间及其术后在体内消除时间,安全性较好,具有一定的临床推广应用价值。
Objective To observe the effect of dexmedetomidine on muscle relaxant effect of cisatracurium in pediatric laparoscopic surgery. Methods Forty children with laparoscopic surgery at the First Hospital of Qinhuangdao from January 2014 to January 2016 were randomly divided into control group and treatment group, with 20 cases in each group. Two groups of intravenous injection of benzene sulbored cisatracurium intravenous injection, the induction dose of 0.1 mg / kg, maintaining the dose of 1 ~ 2μg / (kg · min ~ (-1)). The patients in the treatment group were treated with dexmedetomidine hydrochloride injection (3μg / kg) 20 minutes before induction of anesthesia for 15 minutes. After intubation, the rats were injected with dexmedetomidine hydrochloride injection 0.5μg / (kg · h-1) ) Until 20 min before the end of surgery; control group with the same amount of saline instead. The muscle relaxant index, hemodynamic index, muscle relaxation recovery index and Steward score of the two groups were observed. Results The onset time of muscle relaxant in treatment group was significantly shorter than that in control group, with significant difference between the two groups (P <0.05). At induction time, 3 min after intubation and 30 min after extubation, mean arterial pressure (MAP) in the treatment group was significantly lower than that before induction (P <0.05); at the induction time, intubation Time, extubation time and 30 min after extubation, the MAP of the treatment group was significantly lower than that of the control group, the difference was statistically significant (P <0.05). At the time of intubation, the HR of the control group was lower than that of the control group before 20 min. At 30 min after the extubation, the HR of the control group was higher than that of the control group 20 min before induction (P <0.05) , The time of intubation and 30 min after extubation, HR of the treatment group was lower than that of 20 min before induction (P <0.05); at the time of induction, intubation time, 3 min after intubation and 30 min, HR in the treatment group was significantly lower than that in the control group, the difference between the two groups was statistically significant (P <0.05). The onset time of muscle relaxant in the treatment group was significantly shorter than that in the control group, with significant difference between the two groups (P <0.05). There was no significant difference between the two groups in muscle maintenance time. There was no significant difference between the two groups in muscle recovery index and Steward score. Conclusion Dexmedetomidine can enhance the muscle relaxant effect of cisatracurium in children with laparoscopic surgery, but it will not prolong the maintenance time and eliminate the time in vivo after operation, so it is safe and has certain clinical application value.