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目的:研究术前静脉泵注不同剂量的盐酸右美托咪定(DEX)在儿童门诊手术术前用药的临床效果,探讨门诊手术患儿静脉泵注DEX作为术前用药的合理剂量。方法:选取门诊疝囊高位结扎术患儿75例,年龄1~6岁,ASA分级Ⅰ或Ⅱ级,随机分为DEX 1.00μg/kg(D1.00)组、0.75μg/kg(D0.75)组、0.50μg/kg(D0.50)组各25例。由家长陪同进入麻醉准备室,三组患儿分别于10 min静脉泵注DEX 1.00μg/kg、0.75μg/kg、0.50μg/kg,用药30 min后进入手术室进行手术。记录用药前(T0)、用药后10min(T10)、用药后20 min(T20)、用药后30 min(T30)的心率、平均动脉压和血氧饱和度,并于T10、T20、T30记录患儿镇静评分、儿童麻醉诱导合作评分、患儿入睡所需时间(镇静评分达4分)、术后苏醒时间、术后谵妄发生率及术中心动过缓和低血压发生率。结果:D0.75组与D1.00组镇静评分、麻醉诱导合作评分和入睡时间比较差异无统计学意义,但D1.00组较D0.75组患儿术中心动过缓和低血压发生率显著升高(P<0.05)。D0.75组与D0.50组用药后生命体征变化、术中心动过缓和低血压发生率以及术后谵妄发生率比较差异无统计学意义,但D0.50组较D0.75组入睡所需时间延长,同时麻醉诱导合作评分降低(P<0.05)。结论:DEX作为儿童术前用药,对自主呼吸没有抑制作用,对生命体征影响小,且静脉泵注0.75μg/kg DEX较0.50μg/kg和1.00μg/kg为更适合的术前用药剂量。
Objective: To study the clinical effect of preoperative intravenous infusion of different doses of dexmedetomidine hydrochloride (DEX) in preoperative outpatient surgery in children, and to explore the value of intravenous injection of DEX in outpatients as a reasonable dose of preoperative medication. Methods: Seventy-five children aged 1 to 6 years with ASA grading Ⅰ or Ⅱ were randomly divided into three groups: DEX 1.00 μg / kg (D1.00), 0.75 μg / kg ) Group and 25 cases in 0.50μg / kg (D0.50) group. Accompanied by parents into the anesthesia preparation room, three groups of children were intravenously injected DEX 1.00μg / kg, 0.75μg / kg, 0.50μg / kg at 10 min, 30min after the operation into the operating room for surgery. The heart rate, mean arterial pressure and blood oxygen saturation were recorded before treatment (T0), 10 min after administration (T10), 20 min after administration (T20) and 30 min after administration, and recorded on T10, T20 and T30 Pediatric anesthesia induction cooperation score, the time required for children to fall asleep (sedation score of 4), postoperative recovery time, the incidence of postoperative delirium and the incidence of bradycardia and hypotension. Results: There was no significant difference in sedation score, cooperation-induced anesthesia score and time to fall asleep between D0.75 group and D1.00 group, but the incidence of bradycardia and hypotension was significantly higher in D1.00 group than in D0.75 group Increased (P <0.05). D0.75 group and D0.50 group after treatment, changes in vital signs, intraoperative bradycardia and hypotension incidence and incidence of postoperative delirium was no significant difference, but D0.50 group than the D0.75 group needed to fall asleep The time was prolonged and the co-operative score of anesthesia was decreased (P <0.05). CONCLUSION: DEX, as a preoperative medication for children, has no inhibitory effect on spontaneous breathing and little effect on vital signs. Intravenous infusion of 0.75μg / kg DEX is more suitable for preoperative dosage than 0.50μg / kg and 1.00μg / kg.