右美托咪定用于小儿内镜下腺样体切除术的临床效果

Clinical effect of Dexmedetomidine in pediatric endoscopic adenoidectomy

摘要:

目的 探讨右美托咪定用于小儿腺样体切除术中患儿的应激反应和对术后镇痛、镇静效果的影响。方法 选择择期行内镜下腺样体切除术的患儿91例，年龄3～7岁，随机分为右美托咪定组（D组，n = 45）和生理盐水组（C组，n = 46）。在麻醉诱导前D组给予右美托咪定0.50 μg/kg静脉泵注10 min，C组给予同等体积生理盐水静脉泵注10 min。记录右美托咪定给药前（T₀）、气管插管时（T₁）、手术开始即刻（T₂）、气管拔管时（T₃）的平均动脉压（MAP）、心率（HR），以及拔管后5 min（T₄）、拔管后30 min（T₅）、拔管后1 h（T₆）的小儿术后疼痛评分（CHIPPS）和Ramsay镇静评分。统计麻醉过程中丙泊酚、舒芬太尼和瑞芬太尼的使用量。结果 T₀时点两组患儿MAP和HR比较，差异无统计学意义，T₁～T₃时点D组的MAP和HR均低于C组（P < 0.05）；与C组比较，T₄～T₆时点D组的CHIPPS疼痛评分明显降低（P < 0.05），而T₄～T₆时点D组的Ramsay镇静评分明显增高（P < 0.05）。两组患者丙泊酚、舒芬太尼和瑞芬太尼用量比较，差异均无统计学意义（P > 0.05）。结论 术前给予0.50 μg/kg右美托咪定可减轻内镜下腺样体切除术患儿的应激反应、缓解术后疼痛并维持良好的镇静效果，值得临床推广应用。

Abstract:

Objective To investigate the effect of Dexmedetomidine on stress response and postoperative analgesia and sedation in children underwent adenoidectomy.Methods 91 children, aged 3～7 years old, underwent adenoidectomy were enrolled in this study. Patients were randomly assigned to receive either intravenous 0.50 μg/kg Dexmedetomidine (Group D, n = 45) or the same volume of saline (Group C, n = 46) 10 min before induction. The parameters of stress response (MAP, HR) were recorded at the following time points: before Dexmedetomidine administration (T₀), intubation (T₁), the beginning of operation (T₂), extubation (T₃). The scores for the children's and infants' postoperative pain scale (CHIPPS) and Ramsay scale were recorded 5 min after extubation (T₄), 30 min after extubation (T₅) and 1 h after extubation (T₆). The dosages of Propofol, Sufentanil and Remifentanil during anesthesia were calculated.Results Dexmedetomidine significantly suppressed the parameters of stress response at T₁～T₃ (P < 0.05). Compared with group C, CHIPPS were significantly lower in group D at T₄～T₆ (P < 0.05), while Ramsay scores were significantly higher in group D at T₄～T₆ (P < 0.05). There were no significant differences in the dosages of Propofol, Sufentanil and Remifentanil between the two groups (P > 0.05).Conclusion 0.50 μg/kg Dexmedetomidine premedication may downregulate the stress response, control pain and maintain sedation during postoperative recovery, which is worthy of clinical application.