摘要
目的观察小剂量右美托咪定在小儿气管插管静吸复合全身麻醉中的作用,为麻醉安全用药提供依据。方法 2011年1月至7月在武汉市妇女儿童医疗保健中心住院拟行鼾症根治术和眼睑内翻矫治术的患儿纳入研究,随机分为3组:A组(诱导麻醉开始时予右美托咪定0.5μg/kg),B组(诱导麻醉开始时予右美托咪定1.0μg/kg)及C组(不予右美托咪定)。3组患儿均采用气管插管静吸复合全身麻醉方法,观察并记录不同时点患儿心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PetCO2)、潮气量和呼吸频率,进行镇静程度评分,记录各组呼吸抑制及躁动发生率。结果共120例年龄4～11岁患儿纳入研究,其中男80例,女40例。A、B、C组各40例。3组患儿一般情况及手术时间差异均无统计学意义(均P>0.05)。3组患儿在不同时点的SpO2、PetCO2、潮气量与呼吸频率的差异均无统计学意义(均P>0.05)。术后A、B、C组患儿中分别有1例(2.5%)、2例(5.0%)、5例(12.5%)出现呼吸抑制,经面罩加压给氧后均缓解。A、B组患儿应用右美托咪定后均出现心率下降和MAP升高,但均在正常范围内,均能自行或给予阿托品后恢复至基础值。A、B组患儿术后躁动发生率分别为5.0%(2/40)和2.5%(1/40),明显低于C组(22.5%,9/40,P<0.05)。B组患儿镇静过度发生率(12.5%,5/40)高于A组(2.5%,1/40,P<0.05)。结论小儿气管插管全麻诱导麻醉时静脉输注小剂量右美托咪定(0.5μg/kg)可有效预防患儿术后呼吸抑制及躁动的发生,安全有效。
Objective To observe the safety of low-dose dexmedetomidine used in children undergoing combined inhaled and intravenous general anesthesia with tracheal intubation in order to provide the basis for safe drug use in clinical practice.Methods The children,who were scheduled to undergo radical surgery for snoring and surgical correction of entropion at Wuhan Medical Health Center for Women and Children from January to July in 2011,were enrolled in the study.The children were randomly divided into three groups： group A（receiving an IV infusion of dexmedetomidine 0.5 μg/kg at the beginning of anesthesia induction）,group B（receiving an IV infusion of dexmedetomidine 1.0 μg/kg at the beginning of anesthesia induction） and group C（receiving no dexmedeto-midine）.Combined inhaled and intravenous general anesthesia with tracheal intubation was used in children in the three groups.The children＇s heart rate（HR）,mean arterial pressure（MAP）,pulse oxygen saturation（SpO2）,partial pressure of carbon dioxide in end-expiratory gas（PetCO2）,tidal volume and respiratory rate were observed and recorded.The degree of sedation was scored.The incidences of respiratory depression and dysphoria in the three groups were recorded.Results A total of 120 children aged 4-11 years were enrolled in the study,and comprised 80 boys and 40 girls.Each group consisted of 40 children.There were no statistically significant in baseline characteristics and the operation time among the children in the three groups（all P0.05）.There was no statistically significant difference in SpO2,PetCO2,tidal volume and respiratory rate at different time points among the three groups（all P0.05）.The cases of respiratory depression after operation in groups A,B and C were one case（2.5%）,2 cases（5.0%） and 5 cases（12.5%）,respectively.The degree of respiratory depression remitted after administration of hyperbaric oxygen via a face mask.HR decreased and MAP increased in the children in groups A and B after receiving dexmedetomidine,but the changes were in normal range and returned to the baseline spontaneously after receiving atropine.The incidence of dysphoria in groups A and B after operation was 5.0%（2/40） and 2.5%（1/40）,respectively,and was significantly lower than that in group C（22.5%,9/40）（P0.05 for all comparison）.The incidence of excessive sedation in the children in the group B（12.5%,5/40） was higher than that in the group A（2.5%,1/40）（P0.05）.Conclusion An IV infusion of low-dose dexmedetomidine（0.5 μg/kg） used in children undergoing combined inhaled and intravenous general anesthesia with intracheal intubation could prevent respiratory depression and dysphoria after surgery,and it might be a safe and effective regimen.
出处
《药物不良反应杂志》
2012年第4期210-213,共4页
Adverse Drug Reactions Journal
关键词
右美托咪定
小儿
气管插管静吸复合全身麻醉
安全性
dexmedetomidine
child
combined inhaled and intravenous general anesthesia
safety
