右美托咪定辅助下的静吸复合麻醉在小儿气管异物取出术的应用

发布时间：2018-06-09 13:30

本文选题：右美托咪定 + 静吸复合麻醉　；参考：《药品评价》2016年15期

【摘要】：目的:探究分析右美托咪定辅助下静吸复合麻醉应用于小儿气管异物取出术的效果。方法:选2015年6月至2016年6月赣州市人民医院收治的90例行支气管镜检术患儿,随机平均分作三组:P组(丙泊酚+瑞芬太尼+表面麻醉)、D组(右美托咪定+丙泊酚+瑞芬太尼+表面麻醉)、L组(喉罩+丙泊酚+瑞芬太尼+右美托咪定)。患儿入室后经面罩吸入七氟醚5min,之后用2%利多卡因对气管内、咽喉部与舌根部行表面麻醉。在此基础上给予P组患儿静脉泵入瑞芬太尼0.1μg/(kg·min)、丙泊酚0.15mg/(kg.min)维持麻醉至手术结束。对于D组则在表面麻醉后将右美托咪定经微量泵按2μg/kg的负荷剂量以恒定速度在10min内泵完,其后将泵速调整为1μg/(kg·h),于此同时在表面麻醉后静脉泵入瑞芬太尼0.075μg/(kg·min)、丙泊酚0.075mg/(kg.min)维持麻醉至手术结束。L组与D组麻醉方式相同,但是在术前2mim可弯曲喉罩,各组均于表面麻醉15min后开始进行手术操作。比较三组各时刻麻醉诱导前(T_0)、表面麻醉后15min(T_1)、置镜后1min(T_2)、置镜后5min(T_3)患者的心率(heart rate,HR)、呼吸频率(respiratory rate,RR)、脉搏氧饱和度(SpO_2)、平均动脉压(mean arterial pressure,MAP),比较麻醉开始后、术中及术后不良反应包括呼吸抑制、恶心、心动过速、喉痉挛、心动过缓、躁动、呛咳等的发生率,观察经可弯曲喉罩行硬质支气管镜气管异物取出的成功率。在HR、RR、SpO_2、MAP的组间比较时,T_0时刻三组两两比较差异无统计学意义(P0.05),T_1、T_2、T_3时刻,P组与D组、L组比较差异有统计学意义(P0.05)。在HR、RR、SpO_2、MAP的组内比较时,除T_2与T_3时刻比较差异无统计学意义(P0.05),其余时刻两两比较差异有统计学意义(P0.05)。三组患儿麻醉过程中及术中、术后不良反应发生率的比较,D组与L组比较差异无统计学意义(P0.05),P组与D组、L组呛咳、呼吸抑制的比较差异有统计学意义(P0.05)。经可弯曲喉罩行硬质支气管镜气管异物取出的成功率为50%,其中主气管异物8例,右支气管异物4例,左支气管异物3例。结论:右美托咪定辅助的静吸复合麻醉应用于小儿气管异物取出术呼吸、循环系统相对稳定,不良反应的发生率较低,是一种较为安全、可行的硬质支气管镜气管异物取出术的麻醉方法。经可弯曲喉罩的硬质支气管镜气管异物取出术成功率不高,主要适用于主气管的异物取出术。
[Abstract]:Objective: to investigate the effect of dexmetomidine-assisted combined intravenous anesthesia on trachea foreign body removal in children. Methods: from June 2015 to June 2016, 90 children with bronchoscopy were selected from Ganzhou people's Hospital. They were randomly divided into three groups: propofol remifentanil topical anesthesia group D (dexmetomidine propofol remifentanil topical anesthesia) group L (laryngeal mask propofol remifentanil dexmetromidine). Sevoflurane was inhaled by mask for 5 min, and then 2% lidocaine was used to anesthetize the trachea, throat and tongue. On this basis, group P was given intravenous infusion of remifentanil 0.1 渭 g/(kg, propofol 0.15 mg / min) to maintain anesthesia until the end of the operation. For group D, after topical anesthesia, dexmetidine was pumped in 10min at a constant speed of 2 渭 g/kg at a loading dose of 2 渭 g/kg. Then, the pump speed was adjusted to 1 渭 g/(kg 路min. After surface anesthesia, remifentanil was injected intravenously into remifentanil (0.075 渭 g/(kg 路min), propofol 0.075 mg / kg 路min). The anesthesia of group L was the same as that of group D until the end of operation, but the larynx mask could be bent by 2mim before operation. All groups were operated after surface anesthesia of 15min. The heart rate, respiratory rate, pulse oxygen saturation and mean arterial pressure were compared between the three groups before anesthesia induction, 15 min after anesthesia, 1 min after anesthesia, 5 min after endoscopy, 5 min after endoscopy.) after anesthesia, the heart rate, respiratory rate, oxygen saturation, oxygen saturation and mean arterial pressure were compared between the three groups. The adverse reactions included respiratory depression, nausea, tachycardia, laryngeal spasm, bradycardia, restlessness, cough and so on. There was no significant difference between the three groups at the time of T _ 0. There was no significant difference between P _ (0.05) and T _ (1) T _ (2) T _ (3). There was significant difference between P group and D group (P 0.05). There was no significant difference between T _ 2 and T _ 3 in the group of RRSpO2MAP, but there was a significant difference in the other two moments (P 0.05). Comparison of the incidence of adverse reactions during anesthesia and during operation in the three groups there was no significant difference between group D and group L. there was no significant difference between group D and group D in choking cough and respiratory inhibition in group D (P 0.05) and group D (P 0.05). The successful rate of tracheal foreign body removal by flexible laryngeal mask was 50%, including 8 cases of main tracheal foreign body, 4 cases of right bronchus foreign body and 3 cases of left bronchial foreign body. Conclusion: dexmetomidine-assisted combined intravenous anesthesia is a safe method for the removal of trachea foreign bodies in children, the circulatory system is relatively stable and the incidence of adverse reactions is relatively low. A feasible anesthetic method for removing foreign body from trachea by rigid bronchoscope. The successful rate of tracheobronchial foreign body removal with flexible laryngeal mask is not high, which is mainly suitable for the removal of foreign body from the main trachea.
【作者单位】：赣州市人民医院麻醉科;
【基金】：江西省卫生计生委科技计划(编号:20167215)
【分类号】：R726.1

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