CAJ | 학술논문

目的：观察术中使用右美托咪定对扁桃体、腺样体摘除术患儿麻醉及术后镇痛的影响。方法将ASA分级Ⅰ～Ⅱ级，择期行扁桃体、腺样体摘除术患儿58例，分为对照组（C组，n＝22）、右美托咪定Ⅰ组（D1组，n＝18）、右美托咪定Ⅱ组（D2组，n＝18）。3组麻醉诱导及维持方案相同。D1、D2组患儿术中给予右美托咪定0．75mg/kg，C组患儿于相同时间给予等体积生理盐水作为对照。手术结束后，C组、D1组术后镇痛配方如下：舒芬太尼2μg/kg，曲马多5mg/kg，地塞米松0．5mg，恩丹西酮2mg。D2组术后镇痛配方中舒芬太尼减低为1μg/kg，其余不变。均以生理盐水稀释至100mL，采用相同型号一次性镇痛泵给予，速率为2mL/h。于下述时刻观察并记录患儿血压和心率：麻醉诱导前（T0），气管插管后即刻（T1），气管插管后5、10、15、20min（T2～T5），手术结束时（T6）；术毕停药后记录患儿自主呼吸恢复时间、拔管时间、解除监护时间；术后6h内每小时观察记录患儿心率、呼吸频率、血氧饱和度及镇静、镇痛评分。结果术中患儿血流动力学稳定，术后自主呼吸恢复时间、拔管时间、解除监护时间组间比较，差异无统计学意义（P＞0．05）；术后观察期内，3组患儿心率、呼吸频率及镇静、镇痛评分比较，差异无统计学意义（P＞0．05）。结论术中使用右美托咪定，对扁桃体、腺样体摘除术患儿血流动力学无不良影响，不影响麻醉后苏醒质量，具有术后镇痛效果。
목적：관찰술중사용우미탁미정대편도체、선양체적제술환인마취급술후진통적영향。방법장ASA분급Ⅰ～Ⅱ급，택기행편도체、선양체적제술환인58례，분위대조조（C조，n＝22）、우미탁미정Ⅰ조（D1조，n＝18）、우미탁미정Ⅱ조（D2조，n＝18）。3조마취유도급유지방안상동。D1、D2조환인술중급여우미탁미정0．75mg/kg，C조환인우상동시간급여등체적생리염수작위대조。수술결속후，C조、D1조술후진통배방여하：서분태니2μg/kg，곡마다5mg/kg，지새미송0．5mg，은단서동2mg。D2조술후진통배방중서분태니감저위1μg/kg，기여불변。균이생리염수희석지100mL，채용상동형호일차성진통빙급여，속솔위2mL/h。우하술시각관찰병기록환인혈압화심솔：마취유도전（T0），기관삽관후즉각（T1），기관삽관후5、10、15、20min（T2～T5），수술결속시（T6）；술필정약후기록환인자주호흡회복시간、발관시간、해제감호시간；술후6h내매소시관찰기록환인심솔、호흡빈솔、혈양포화도급진정、진통평분。결과술중환인혈류동역학은정，술후자주호흡회복시간、발관시간、해제감호시간조간비교，차이무통계학의의（P＞0．05）；술후관찰기내，3조환인심솔、호흡빈솔급진정、진통평분비교，차이무통계학의의（P＞0．05）。결론술중사용우미탁미정，대편도체、선양체적제술환인혈류동역학무불량영향，불영향마취후소성질량，구유술후진통효과。
Objective To investigate the effects of dexmedetomidine on anesthesia and postoperative analgesia in children under-going adenoidectomy and tonsillectomy.Methods 58 children aged 2-12 years old,ASA rated as Ⅰ or Ⅱ level,scheduled to re-ceive selective adenotonsillectomy were divided into three groups at random,group C(n=22),group D1 (n=18)and group D2 (n=18).The anesthesia induction and the anesthesia maintaining scheme were same in 3 groups.Dexmedetomidine 0.75μg/kg was intr-aoperatively given in the group D1 and D2 ,while the same volume of normal saline was given in the group C as control at the same time.After operation,postoperative analgesia recipe in the group C and D1 was sulfentanyl 2μg/kg,tramadol 5 mg/kg dexametha-sone 0.5 mg and ondansetron 2 mg,which in the group D2 was same except reducing sulfentanyl to 1μg/kg.All were diluted to 100mL by normal saline and given by the same type of disposable infusion pump at a rate of 2 mL/h.The blood pressure and heart rate were observed and recorded before anesthesia induction(T0 ),instantly after endotrachel intubation(T1 ),at 5,10,15,20 min af-ter endotrachel intubation(T2-T5 )and the operation end(T6 );the autonomous respiration recovery time,extubation time,remo-ving monitoring time after operation and drug withdrawal were recorded;the heart rate,respiration rate,SpO2 ,and sedation and an-algesia scores were observed and recorded per 1 h within postoperative 6 h.Results The intraoperative hemodynamics was stable. The postoperative autonomous respiration recovery time,extubation time and removing monitoring time had no statistical differ-ences among 3 groups(P>0.05);during the postoperative observation period,the heart rate,respiration rate,sedation and analgesia scores had no statistical difference among 3 groups(P>0.05).Conclusion Intraoperative dexmedetomidine has no adverse influ-ence on the hemodynamics without affecting the recovery quality after anesthesia and possesses the postoperative analgesic effect.