CAJ | 학술논문

目的：观察右美托咪啶对青少年特发性脊柱侧弯矫形术后谵妄的影响．方法选择青少年特发性脊柱侧弯患者160例，年龄7～16岁，ASAⅡ～Ⅲ，麻醉诱导插管后随机分为2组（n＝80），SS组：舒芬太尼0.2μg/(kg.h)泵注，呼气末七氟醚靶浓度1%～2%吸入维持麻醉；SSD组：舒芬太尼0.2μg/(kg.h)泵注，呼气末七氟醚靶浓度1%～2%吸入，右美托咪啶0.2μg/h泵注维持麻醉，调整七氟醚靶浓度维持BIS值40～60，应用血管活性药维持MAP 65～75 mmHg．术毕记录手术时间、术中出血量、输血量、七氟醚用量、舒芬太尼用量、右美托咪啶用量、呼吸恢复时间、麻醉恢复时间、清醒时间、术后2h内躁动发生情况及术后3d谵妄发生情况．结果2组患者手术时间、术中出血量、输血量、舒芬太尼用量、呼吸恢复时间、麻醉恢复时间、清醒时间差异无统计学意义，SS组七氟醚用量明显多于SSD组（＜0.05），术后2 h内躁动发生率及术后3 d谵妄发生率也明显高于SSD组．结论术中辅助应用右美托咪啶0.2μg/h可减少青少年特发性脊柱侧弯术后谵妄的发生．
목적：관찰우미탁미정대청소년특발성척주측만교형술후섬망적영향．방법선택청소년특발성척주측만환자160례，년령7～16세，ASAⅡ～Ⅲ，마취유도삽관후수궤분위2조（n＝80），SS조：서분태니0.2μg/(kg.h)빙주，호기말칠불미파농도1%～2%흡입유지마취；SSD조：서분태니0.2μg/(kg.h)빙주，호기말칠불미파농도1%～2%흡입，우미탁미정0.2μg/h빙주유지마취，조정칠불미파농도유지BIS치40～60，응용혈관활성약유지MAP 65～75 mmHg．술필기록수술시간、술중출혈량、수혈량、칠불미용량、서분태니용량、우미탁미정용량、호흡회복시간、마취회복시간、청성시간、술후2h내조동발생정황급술후3d섬망발생정황．결과2조환자수술시간、술중출혈량、수혈량、서분태니용량、호흡회복시간、마취회복시간、청성시간차이무통계학의의，SS조칠불미용량명현다우SSD조（＜0.05），술후2 h내조동발생솔급술후3 d섬망발생솔야명현고우SSD조．결론술중보조응용우미탁미정0.2μg/h가감소청소년특발성척주측만술후섬망적발생．
Objective To investigate the effect of dexcedetomidine on the postoperative delirium in adolescent idiopathic scoliosis undergoing spine surgery. Methods 160 patients (7-16 years of age) with idiopathic scoliosis undergoing posterior spinal fusion were randomly divided in to two groups. Group SS (n=80) included patients anesthetized with sevorane and sufentanil, group SSD (n=80) included patients anesthetized with sevorane,sufentanil and dexcedetomidine. In the latter group, dexcedetomidine was administered as a continuous infusion of 0.2 ug/h started after the induction of anesthesia without a loading dose. Sevorane was adjusted to maintain the bispectral index (BIS) number at 40-60 and vasoactive drugs was adjusted to maintain the mean arterial pressure (MAP) at 65-75 mmHg. The amount of anesthetic, the time of anesthesia recovery,restlessness during recovery and postoperative delirium were recorded. Results The amount of sevorane, the incidence of restlessness during recovery and the incidence of postoperative delirium were significantly lower in the group SSD than in group SS ( <0.05) . Conclusion The perioperative infusion of 0.2 ug/h dexcedetomidine can decrease the incidence of postoperative delirium in adolescent idiopathic scoliosis undergoing spine surgery.