右美托咪定联合氯胺酮滴鼻用于小儿术前镇静的效果评估

发布时间：2018-06-06 10:57

本文选题：右美托咪定 + 氯胺酮　；参考：《重庆医科大学学报》2017年12期

【摘要】：目的:观察右美托咪定联合氯胺酮滴鼻用于小儿术前镇静的效果及安全性。方法:选择于我院2016年3至6月拟行腭咽成形术、扁桃体摘除术,美国麻醉师协会(American Society of Anesthesiologists,ASA)I~Ⅱ级,年龄2~6岁的患儿155例,随机分为4组:D1组(n=37)和D2组(n=40)分别接受右美托咪定1μg/kg或2μg/kg滴鼻;D1+K组(n=38)及D2+K(n=40)组均接受1μg/kg或2μg/kg右美托咪定滴鼻,同时另一鼻孔行1 mg/kg氯胺酮滴鼻,40 min后转送入手术室,接受全身麻醉,术毕送入复苏室。滴鼻后每15 min记录患儿的心率(heart rate,HR)、平均动脉血压(mean arterial pressure,MAP)及血氧饱和度(oxygen saturation,SpO_2),记录准备转运到手术室时(T1)及麻醉诱导时(T2)改良镇静评分(modified observer's assessment of alertness/sedation score,m OAAS),记录镇静起效时间、手术时间、麻醉时间、苏醒时间、苏醒期躁动评分(pediatric anesthesia emergence delirium scale,PAED)、术后疼痛评分(face,legs,activity,crying,consolability scale,FLACC)及不良事件发生情况等。结果:4组患儿一般情况及麻醉时间、手术时间均无差异;D2+K组与其余3组(D1、D2、D1+K)比较镇静起效时间显著缩短(P0.05);T1及T2时间点D2+K组与其余3组(D1、D2、D1+K)比较镇静成功率明显升高(P0.01);D2组心动过缓发生率较其余3组显著升高(P0.05),4组患儿苏醒时间、苏醒期躁动评分、术后疼痛评分无统计学差异。结论:右美托咪定与氯胺酮联合用药提高了术前镇静的成功率,缩短镇静起效时间,是一种安全有效、方便易行的小儿术前用药方法。
[Abstract]:Objective: To observe the effect and safety of dexmedetomidin combined with ketamine intranasal for children's sedation. Methods: selected in our hospital from 3 to June 2016, palatopalatyngoplasty, tonsillectomy, American Society of Anesthesiologists, ASA I~ II, and 155 children aged 2~6, randomly divided into 4 groups: D1 (n=) 37) and group D2 (n=40) received dexmedetomidine 1 g/kg or 2 g/kg dripping nose, D1+K group (n=38) and D2+K (n=40) group received 1 u g/kg or 2 mu dexmedetomidin nose drops, while the other nose bore 1 mg/kg ketamine nose drops, 40 min was transferred into the operation room, received whole body drunken and sent to the resuscitation room. Eart rate, HR), the mean arterial blood pressure (mean arterial pressure, MAP) and blood oxygen saturation (oxygen saturation, SpO_2). Record the preparation for the delivery to the operation room (T1) and the induction of anesthesia induction (T2), to record the time of the sedative effect, the time of operation, and the time of anesthesia. The awakening time, pediatric anesthesia emergence delirium scale, PAED, postoperative pain score (face, legs, activity, crying, consolability scale) and the occurrence of adverse events. Results: there was no difference in the general condition of the 4 groups and the time of anesthesia and the operation time. Sedative onset time was significantly shortened (P0.05); T1 and T2 time point D2+K group compared with the other 3 groups (D1, D2, D1+K), the rate of sedation success was significantly higher (P0.01); the occurrence rate of bradycardia in the D2 group was significantly higher than the other 3 groups (P0.05), the 4 groups of children awakening time, the restless evaluation of the awakening period, and no statistical difference in postoperative pain scores. Conclusion: right metomomidin and chloramine Ketone combination can improve the success rate of sedation before operation and shorten the onset time of sedation. It is a safe, effective and convenient method for pre-operative medication in children.
【作者单位】：重庆医科大学附属儿童医院麻醉科儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室;
【分类号】：R726.1

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