右美托嘧啶用于儿童扁桃体、腺样体切除术术后镇静效果的临床观察

发布时间：2018-06-08 18:38

本文选题：右美托嘧啶 + 小儿麻醉　；参考：《吉林大学》2013年硕士论文

【摘要】：背景：扁桃体、腺样体切除术是儿童最常见的一种手术，术后即刻的一段时间是非常关键的。这些儿童通常感到明显疼痛，但是存在术后呼吸道水肿和伴随的对阿片类镇痛药物的高敏性，极易导致呼吸道阻塞症状和低氧血症。非甾体抗炎药物可以降低阿片类药物的用量，但是这些药物会增加此类手术术后出血的风险。右美托嘧啶（dexmedetomidine，，DxM）有轻度镇痛的性能，具有非呼吸抑制性的镇静作用，且对凝血系统没有影响。目的：观察右美托嘧啶在行扁桃体、腺样体切除术儿童的镇静效果并指导临床用药。方法：本研究为前瞻性、双盲随机性实验，旨在判断行扁桃体、腺样体手术的儿童术中应用DxM对术后苏醒期疼痛、镇静和血流动力学的影响效果。60名患者被随机分成4组，分别注射芬太尼2μg/kg联合DxM0.5μg/kg；芬太尼2μg/kg；芬太尼4μg/kg联合DxM0.5μg/kg；芬太尼4μg/kg。术后观察患儿在PACU的血流动力学指标以及镇静评分，并根据躁动情况选择追加给药的次数和剂量，并记录在PACU的停留时间。结果：各组患儿的一般资料差异无显著性。（1）接受DxM治疗的2组患儿在手术开始后心率减慢差异性显著(P0.05)；与诱导前的基础心率相比，单纯接受芬太尼治疗的患儿术后10min内心率明显升高。（2）与单纯接受芬太尼2μg/kg组相比，输注芬太尼2μg/kg联合DxM组和输注芬太尼4μg/kg组的拔管时间差异性不显著，但是接受芬太尼4μg/kg联合DxM的患儿拔管时间延长差异性显著。（3）除4μg/kg芬太尼联合DxM组的患儿在PACU停留时间明显延长外，其他各组患儿在PACU停留的时间差异无显著性。结论：右美托嘧啶用于儿童扁桃体、腺样体切除术的麻醉，可以减少阿片类镇痛药（如芬太尼）的用量，且可以稳定术后血流动力学，但不延长术后的拔管和在PACU滞留时间。
[Abstract]:Background: tonsillectomy, adenoidectomy is the most common surgical procedure in children. These children usually feel obvious pain, but there is postoperative respiratory edema and Gao Min associated with opioid analgesic drugs, which can easily lead to respiratory obstruction and hypoxemia. Non-steroidal anti-inflammatory drugs can reduce opioid use, but these drugs increase the risk of bleeding after such operations. Dexmetropyrimidine dexmedetomidineine (DxM) has the properties of mild analgesia, nonrespiratory inhibition, and no effect on the coagulation system. Methods: a prospective, double-blind randomized trial was conducted in children undergoing adenoidectomy. Effects of sedation and hemodynamics. 60 patients were randomly divided into four groups: fentanyl 2 渭 g/kg combined with DxM0.5 渭 g / kg; fentanyl 2 渭 g / kg; fentanyl 4 渭 g/kg + DxM0.5 渭 g / kg; The hemodynamic indexes and sedation scores of PACU were observed after operation, and the frequency and dosage of additional administration were selected according to the restlessness. Results: there was no significant difference in general data between the two groups (P < 0.05). There was no significant difference in extubation time between fentanyl 2 渭 g/kg combined with DxM group and fentanyl 4 渭 g/kg group compared with fentanyl 2 渭 g/kg group. However, the extubation time of fentanyl 4 渭 g/kg combined with DxM group was significantly longer than that of 4 渭 g/kg fentanyl plus DxM group. There was no significant difference in the length of stay in PACU among the other groups. Conclusion: the use of dexmetazil in anaesthesia of tonsillectomy and adenoidectomy can reduce the dosage of opioid analgesics (such as fentanyl). It can stabilize hemodynamics, but does not prolong extubation and stay in PACU.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R614.2

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