术前经鼻使用右美托咪定对行腺样体扁桃体切除术患儿的临床效果

发布时间：2018-06-15 10:43

本文选题：脑电双频指数 + 右美托咪定　；参考：《上海医学》2015年08期

【摘要】：目的观察术前经鼻使用右美托咪定对患有阻塞性睡眠呼吸暂停综合征(OSAS)患儿的围术期镇静效果、血流动力学和脑电双频指数(BIS)的影响。方法选取56例行腺样体扁桃体切除术的OSAS患儿,将其随机分入对照组和右美托咪定组,每组28例。对照组经鼻予以0.9%氯化钠溶液0.01mL/kg,右美托咪定组经鼻予右美托咪定1μg/kg,记录两组患儿的手术时间、给药后至术前30min入睡例数、停药至自主呼吸时间、停药至拔除气管导管时间、停药至睁眼时间,以及苏醒期躁动发生率。分别于经鼻给药前(T_0),给药后1、5、10、15、20、25、30min(T_1至T_7),麻醉诱导前(T_8)、诱导后即刻(T_9),气管插管前(T_10),气管插管后即刻和3、5、10min(T_11至T_14),手术结束(T_15),自主呼吸恢复(T_16),拔除气管导管即刻(T_17),拔除气管导管后5min送入麻醉后恢复室(PACU,T_18),入PACU后15、30、45min(T_19至T_21),出PACU(T_22)共23个时间点,监测患儿的心率(HR)、脉搏血氧饱和度(SpO2)、平均动脉压(MAP)和BIS值。于插管前对患儿进行Ramsay镇静评分和合作评分。手术结束后评价全身麻醉效果,并行Steward苏醒评分和镇静、躁动评分。结果右美托咪定组停药至自主呼吸恢复时间、停药至拔除气管导管时间分别显著长于对照组(P值均0.05),入睡例数显著多于对照组(P0.05);两组间手术时间、停药至睁眼时间和苏醒期躁动发生率的差异均无统计学意义(P值均0.05)。对照组T_5、T_7至T_12、T_15至T_22时间点的HR,T_4至T_6、T_11、T_13至T_16、T_19时间点的MAP,以及T_5至T_8、T_10时间点的BIS均显著高于右美托咪定组同时间点(P值均0.05)。两组间各时间点的S_pO_2的差异均无统计学意义(P值均0.05)。右美托咪定组T_5至T_8时间点的Ramsay镇静评分和合作评分均显著优于对照组同时间点(P值均0.05),T_0至T_4、T_9至T_11时间点两项评分的差异均无统计学意义(P值均0.05)。两组间T_15至T_22时间点清醒分级、Steward苏醒评分和SAS评分的差异均无统计学意义(P值均0.05)。结论术前经鼻使用右美托咪定可提高患儿术前合作程度,减少术中血流动力学波动,但并不能降低术后躁动发生率。
[Abstract]:Objective to observe the perioperative sedation, hemodynamics and bispectral index (BIS) of dexmetidine in children with obstructive sleep apnea syndrome (OSAS). Methods 56 children with OSAS underwent adenoidectomy were randomly divided into control group and dexmetomidine group with 28 cases in each group. The control group was given 0.9% sodium chloride solution 0.01 mL / kg, and the right metoimidine group was given dexmetomidine 1 渭 g / kg through the nose. The operation time, the number of 30min sleeping cases, the time between withdrawal and extubation of trachea catheter were recorded. The time from withdrawal to open eyes, and the incidence of restlessness during the recovery period. Before the nasal administration, after the administration of the drug, at 1: 5, 10, 15, 15, 25, 25, 30 minutes. Before induction, before the induction of anesthesia, by T8, immediately after induction, by T9, immediately after intubation, by T10, immediately after tracheal intubation, by 3 510 min. T11 to T14, by the end of the operation, by T15T, by the recovery of spontaneous respiration, by T1616, by the extubation of the tracheal duct, by the extubation of the trachea, by the extubation of the tracheal duct, by the extubation of the trachea, by the extubation of the tracheal duct. The 5min was put into the anaesthetized recovery room after the tube and the PACUT 18s. After entering the PACU, there were 23 time points, 153045 mins, T19 to T21, and the PACUT 22). Heart rate (HRG), pulse oxygen saturation (SPO _ 2), mean arterial pressure (map) and BIS were monitored. Ramsay sedation score and cooperative score were performed before intubation. The effect of general anesthesia was evaluated after operation, followed by Steward recovery score, sedation score and restlessness score. Results the time between withdrawal and extubation of trachea catheter in dexmetomidine group was significantly longer than that in control group (P < 0.05), and the number of cases of falling asleep was significantly longer than that of control group (P 0.05). There was no significant difference in the time between withdrawal and eye opening and the incidence of restlessness in recovery period (P < 0.05). In the control group, at the time points T5 / T _ 7 to T _ S _ I _ T _ T _ _ _ There was no significant difference between two groups (P < 0.05). Ramsay sedation score and cooperation score of right metomidine group were significantly higher than those of control group at the same time point (P = 0.05) and between T _ 0 and T _ (4) T _ (9) to T _ (11) time points respectively. There was no significant difference between the two scores (P = 0.05). There was no significant difference between the two groups in the recovery scores of Steward and SAS scores at the time points from T 15 to T 22. There was no significant difference between the two groups (P < 0.05). Conclusion preoperative nasal administration of dexmetidine can improve preoperative cooperation and reduce intraoperative hemodynamic fluctuations, but it can not reduce postoperative restlessness.
【作者单位】：上海交通大学医学院附属新华医院麻醉科;
【分类号】：R726.1

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