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目的观察不同剂量右美托咪定术前滴鼻对扁桃体摘除术患儿安全性的影响。方法行扁桃体摘除术的患儿60例(ASAⅠ级),随机分到高剂量H组、低剂量L组和对照C组,每组20例,麻醉诱导前40 min,H组鼻腔滴入2μg/kg右美托咪定(加生理盐水至0.3 m L),L组鼻腔滴入1μg/kg右美托咪定(加生理盐水至0.3 m L),C组鼻腔滴入0.3 m L生理盐水。观察三组患儿用药后镇静、分离状态、血流动力学、呼吸、拔管时间、PACU停留时间、不良事件发生情况,并监测不同时点血清炎性因子TNF-α和IL-6水平。结果 H组和L组的术前镇静及分离状态明显优于C组,C组患儿心率和血压随时间变化明显,且高于H组和L组(P<0.001),三组患儿各时间点血氧饱和度及拔管时间、PACU停留时间的差异无统计学意义(P>0.05);H组和L组的患儿呛咳、术后躁动的发生率明显低于C组(P=0.024,P=0.025);H组和L组在拔管后即刻、术毕4 h、12 h和24 h的TNF-α、IL-6血浆浓度均低于C组(P<0.001)。结论右美托咪定术前滴鼻能提高患儿镇静水平,改善亲子分离状态,血流动力学平稳,无呼吸抑制,不影响拔管时间,降低不良事件发生,减少围术期炎性因子释放,增加安全性;且使用2μg/kg剂量较1μg/kg更能维持循环稳定,降低炎性因子释放。
Objective To observe the effect of different dosages of dexmedetomidine on the safety of children undergoing tonsillectomy. Methods Totally 60 children (ASA grade Ⅰ) with tonsillectomy were randomly divided into high dose H group, low dose L group and control group C, 20 cases in each group, 40 minutes before induction of anesthesia, 2μg / kg dexmedetomidine plus normal saline to 0.3 m L, 1 μg / kg dexmedetomidine plus 0.3 ml normal saline in Group L, and 0.3 ml normal saline to Group C. The sedation, separation status, hemodynamics, respiration, extubation time, PACU residence time and adverse events were observed in three groups of children. Serum inflammatory cytokines TNF-α and IL-6 were measured at different time points. Results The preoperative sedation and isolation of H group and L group were significantly better than those of C group. The heart rate and blood pressure of H group and L group were significantly higher than those of H group and L group (P <0.001) There were no significant differences in the time of oxygen saturation, extubation time and PACU stay between the two groups (P> 0.05). The incidence of choking and postoperative agitation in children in groups H and L were significantly lower than those in group C = 0.024, P = 0.025). Plasma concentrations of TNF-α and IL-6 at 4 h, 12 h and 24 h after operation in H group and L group were significantly lower than those in C group (P <0.001). Conclusion Dexmedetomidine preoperative intranasal nasal drops can improve the sedation level, improve the parent-child separation, hemodynamic stability, no respiratory depression, does not affect the extubation time, reduce the incidence of adverse events and reduce perioperative inflammatory cytokines Release, increase safety; and the use of 2μg / kg dose more than 1μg / kg to maintain cycle stability, reduce the release of inflammatory cytokines.