CAJ | 학술논문

目的评价右美托咪啶辅助静吸复合全麻用于小儿气管异物取出术的效果.方法拟行气管异物取出术患儿60例,性别不限,年龄1～4岁,体重8 ～ 23 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患儿随机分为静吸复合全麻组(Ⅰ组)和右美托咪啶辅助静吸复合全麻组(Ⅱ组),每组30例.入室后面罩吸入8％七氟醚诱导入睡,入睡后减至4％,Ⅱ组静脉输注右美托咪啶0.5 μg/kg,随后静脉注射异丙酚2 mg/kg,接着静脉输注异丙酚6mg·kg-1·h-1和瑞芬太尼0.15 μg·kg-·min-1维持麻醉,Ⅰ组除不用右美托咪啶外余同Ⅱ组,2 min后停止吸入七氟醚开始置入硬支气管镜.于进镜前、进镜1和5 min时记录HR和SpO2,记录呼吸抑制、喉头水肿和心动过缓等的发生情况,术后记录异丙酚和瑞芬太尼总用量、镜检满意情况及苏醒时间.结果与Ⅰ组比较,Ⅱ组患儿进镜1和5 min时HR降低,进镜1 min时SpO2升高,异丙酚和瑞芬太尼用量减少,手术时间缩短,苏醒时间延长,镜检满意度升高,呼吸抑制和喉头水肿发生率降低(P＜0.05).结论右美托咪啶辅助静吸复合全麻用于小儿气管异物取出术的效果较静吸复合全麻好,且并发症少.
목적 평개우미탁미정보조정흡복합전마용우소인기관이물취출술적효과.방법 의행기관이물취출술환인60례,성별불한,년령1～4세,체중8 ～ 23 kg,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장환인수궤분위정흡복합전마조(Ⅰ조)화우미탁미정보조정흡복합전마조(Ⅱ조),매조30례.입실후면조흡입8％칠불미유도입수,입수후감지4％,Ⅱ조정맥수주우미탁미정0.5 μg/kg,수후정맥주사이병분2 mg/kg,접착정맥수주이병분6mg·kg-1·h-1화서분태니0.15 μg·kg-·min-1유지마취,Ⅰ조제불용우미탁미정외여동Ⅱ조,2 min후정지흡입칠불미개시치입경지기관경.우진경전、진경1화5 min시기록HR화SpO2,기록호흡억제、후두수종화심동과완등적발생정황,술후기록이병분화서분태니총용량、경검만의정황급소성시간.결과 여Ⅰ조비교,Ⅱ조환인진경1화5 min시HR강저,진경1 min시SpO2승고,이병분화서분태니용량감소,수술시간축단,소성시간연장,경검만의도승고,호흡억제화후두수종발생솔강저(P＜0.05).결론 우미탁미정보조정흡복합전마용우소인기관이물취출술적효과교정흡복합전마호,차병발증소.
Objective To investigate the efficacy of dexmedetomidine as an adjunct to combined intravenous-inhalational anesthesia for removal of foreign body in the trachea in children.Methods Sixty ASA Ⅰ or Ⅱ children,aged 1-4 yr,weighing 8-23 kg,were randomly divided into 2 groups(n =30 each):combined intravenous-inhalational anesthesia group(group Ⅰ)and dexmedetomidine as an adjunct to combined intravenous-inhalational anesthesia group(group Ⅱ).In group Ⅱ,8％ sevoflurane was inhaled by mask to induce sleep after entering the operating room,and the concentration was reduced to 4％ after the children sere asleep.Anesthesia was maintained with iv infusion of dexmedetomidine 0.5 μg/kg,and then iv injection of propofo1 2 mg/kg,followed by iv infusion of propofol at 6 rag· kg-1· h-1 and remifentanil at 0-15 μg· kg-1 ·min-t.In group Ⅰ,dexmedetomidine was not used and the other procedures were the same as those in group Ⅱ.Sevoflurane inhalation was stopped 2 min later and the rigid bronchoscope was inserted.HR and SpO2 were monitored and recorded before insertion and at 1 and 5 min after insertion.Complications such as respiratory depression,laryngeal edema,and bradycardia were reconded.The amount of propofol and remifentanil consumed,satisfactory level of bronchoscopy,and emergence time were recorded after operation.Results Compared with group Ⅰ,HR was significantly decreased at 1 and 5 min after insertion,SpO2 was significantly increased at 1 min after insertion,the amount of propofol and remifentanil consumed was significantly reduced,the operation time was significantly shortened,the emergence time was significanlly prolonged,the satisfactory level of bronchoscopy was significandy increased,and the incidence of respiratory depression and laryngeal edema was significantly decreased in grmp Ⅱ(P ＜ 0.05).Conclnslon The efficacy of dexmedetomidine as an adjunct to combined intravenous-inhalational anesthesia is better than that of combined intravenous-inhalational anesthesia for removal of foreign body in the trachea in children,with fewer complications.