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目的:分析右美托咪啶联合神经阻滞在非气管内全麻中的临床应用效果。方法:选取2014年1月至2016年12月韶关市第一人民医院收治的需行手术患儿60例为对象,按照随机数字表将其分为七氟醚组(S组,n=30)及右美托咪定组(D组,n=30)。S组采用七氟醚维持镇静,D组采用右美托咪定维持镇静,全程观察、记录并比较两组患者麻醉前(T0)、骶管阻滞后即刻(T1)、用药后10 min(T2)、用药后30 min(T3)、手术结束时(T4)心率(HR)、平均动脉压(MAP),术中氯胺酮用量、术后苏醒时间、苏醒期躁动评分及不良事件发生率。结果:D组T2、T3、T4时间点的HR明显低于S组,组间比较,差异具有统计学意义(P<0.05),D组T2、T3、T4时间点的MAP明显高于S组,组间比较,差异具有统计学意义(P<0.05);D组的术中氯胺酮用量、苏醒期躁动评分明显少于S组,组间比较,差异具有统计学意义(P<0.05);D组的不良事件发生率为10.0%,S组的不良事件发生率为20.0%,组间比较,差异具有统计学意义(P<0.05)。结论:右美托咪啶联合神经阻滞在非气管内全麻中的麻醉镇静效果优于七氟醚,有效缓解患儿术后不安情况,降低术中氯胺酮用量,有利于患儿预后。
Objective: To analyze the clinical effect of dexmedetomidine combined with nerve block in non-tracheal general anesthesia. Methods: Sixty children underwent surgery from January 2014 to December 2016 in Shaoguan First People’s Hospital. The patients were divided into sevoflurane group (n = 30) according to random number table And dexmedetomidine group (D group, n = 30). S group sevoflurane to maintain sedation, D group with dexmedetomidine to maintain sedation, the whole process of observation, recording and comparison of two groups of patients before anesthesia (T0), immediately after sacral block (T1), 10 min after treatment ( T2), 30 min (T3) after treatment, heart rate (HR) and mean arterial pressure (MAP) at the end of surgery (T4), intraoperative ketamine dosage, postoperative recovery time, wakefulness agitation score and incidence of adverse events. Results: The HR of group D at T2, T3 and T4 was significantly lower than that of group S (P <0.05). The MAP of group D at T2, T3 and T4 was significantly higher than that of group S (P <0.05). The intraoperative ketamine dosage and the restlessness agitation score in group D were significantly less than those in group S (P <0.05). The differences between the two groups were statistically significant (P <0.05), and the difference was statistically significant The incidence of adverse events was 10.0% in group A and 20.0% in group S, and the difference was statistically significant (P <0.05). Conclusion: Dexmedetomidine combined with nerve block anesthesia in non-tracheal anesthesia sedative effect is better than sevoflurane, effective relief of postoperative disturbances in children and reduce intraoperative ketamine levels, is conducive to the prognosis of children.