摘要
目的探讨帕瑞昔布钠联合右美托咪定预防小儿全身麻醉苏醒期不良反应的临床效果。方法将60例行扁桃体剥离合并腺样体吸切手术的全身麻醉患儿按随机数字表法分为3组:帕瑞昔布钠联合右美托咪定组(PD组)、右美托咪定组(D组)、生理盐水组(C组),每组20例。3组均行七氟烷吸入全身麻醉,手术结束前5min PD组静脉注射1mg·kg^(-1)帕瑞昔布钠,微量泵输注0.5μg·kg^(-1)右美托咪定20mL;D组微量泵输注0.5μg·kg^(-1)右美托咪定20mL;C组微量泵输注生理盐水20mL。记录基础状态(T0),拔管前1min(T1),拔管时(T2),拔管后1min(T3)、5min(T4)、15min(T5)、30min(T6)及60min(T7)时MAP、HR、SpO_2,并进行儿童麻醉后躁动评分(PAED)、Ramsay镇静评分、改良加拿大东安大略儿童医院疼痛评分(m-CHEOPS)。记录拔管前后咳嗽、躁动例数及呼吸恢复时间、唤醒时间、拔管时间。结果 3组MAP、HR T0时点比较差异均无统计学意义(P>0.05);其余各时点C组均高于D组、DP组,D组高于DP组,差异均有统计学意义(P<0.05)。PAED评分T4—T6时点C组高于PD组、D组,D组高于DP组,差异均有统计学意义(P<0.05);Ramsay评分T4—T7时点C组低于DP组、D组,差异均有统计学意义(P<0.05);m-CHEOPS评分T4—T7时点C组高于DP组、D组,D组高于DP组,差异均有统计学意义(P<0.05)。3组患儿苏醒时间、拔管时间、呼吸恢复时间比较差异均无统计学意义(P>0.05);咳嗽发生率C组高于DP组和D组,差异有统计学意义(P<0.05);躁动发生率C组高于DP组和D组,D组高于DP组,差异均有统计学意义(P<0.05)。结论帕瑞昔布钠联合右美托咪定能降低扁桃体剥离合并腺样体吸切手术全身麻醉患儿苏醒期躁动、咳嗽发生率,血流动力学平稳而且不延长拔管、苏醒时间。
Objective To investigte the clinical efficacy of parecoxib sodium combined with dexmedetomidine in the prevention of adverse events during recovery from general anesthesia in children.Methods Sixty children undergoing tonsil dissection and adenoidectomy under sevoflu-rane anesthesia were randomly given micro-pump infusion of 20 mL normal saline（group C,n=20）,micro-pump infusion of 20 mL 0.5 μg·kg-1 dexmedetomidine（group D,n=20）,or combined intravenous injection of 1 mg·kg^-1 parecoxib sodium and micro-pump infusion of 20 mL 0.5 μg· kg-1 dexmedetomidine（group DP,n=20）5 minutes before the end of operation.Mean arterial＆amp;nbsp;pressure（MAP）,heart rate（HR）,arterial oxygen saturation（SpO2 ）,Pediatric Anesthesia Emergence Delirium（PAED）score,Ramsay sedation score,and modified Children’s Hospital of Eastern Ontario Pain Scale（m-CHEOPS）score were recorded in the basic state（T0）,1 minute before extubation（T1）,during extubation（T2）,1 minute after extubation（T3）,5 minutes after extubation（T4）,15 minutes after extubation （T5）,15 minutes after extubation（T6）,and 60 minutes after extubation（T7）.In addition,the incidence of cough and emergence delirium,respiratory recovery time,wake-up time,and extubation time were measured in all the three groups.Results There were no significant differences in MAP and HR at T0,as well as in respiratory recovery time,wake-up time and extubation time,among the three groups（P〉0.05）.Compared with group D,MAP and HR increased in group C but decreased in group DP at T1-T7,and PAED score increased in group C but decreased in group DP at T4-T6（P〈0.05）.Compared with group C,Ramsay score increased but m-CHEOPS score decreased in groups D and DP at T4-T7（P〈0.05）. Furthermore,compared with group DP,m-CHEOPS score increased in group D at T4-T7 （P〈0.05）.In addition,compared with group C,the incidence of cough and emergence delirium decreased in groups D and DP（P〈0.05）.Compared with group DP,the incidence of emergence delirium increased in group D（P〈0.05）.Conclusion Parecoxib sodium combined with dexmedetomidine can reduce the incidence of cough and emergence delirium,and has no effects on hemodynamics,wakeup time and extubation time during recovery from general anesthesia in children undergoing tonsil dissection and adenoidectomy.
出处
《实用临床医学（江西）》
CAS
2016年第5期23-26,34,共5页
Practical Clinical Medicine
基金
惠州市科技计划项目基金(2014Y203)
关键词
右美托咪定
帕瑞昔布钠
全身麻醉
苏醒期
不良反应
小儿
dexmedetomidine
parecoxib sodium
general anesthesia
recovery period
adverse events
children
