CAJ | 학술논문

目的评价单次静注右美托咪定对保留自主呼吸七氟烷麻醉唇腭裂患儿苏醒期的影响.方法选择2013年10-12月间在温州医科大学附属第二医院择期先天性唇腭裂修补术患儿60例,随机数字表法分为右美托咪定组(D组)和对照组(C组),每组30例.七氟醚全凭吸入麻醉诱导和维持,术中保留自主呼吸.D组于手术结束前30 min静脉泵注右美托咪定0.5μg/kg 10 min,C组泵入等量生理盐水.观察与记录两组患儿麻醉诱导前(T0)、右美托咪定给药前(T1)、给药完成时(T2)、给药后5 min(T3)、给药后10 min(T4)、术毕(T5)、拔管即刻(T6)、入PACU 5 min(T7)、术后1 h(R)的心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、呼吸频率、潮气量(VT)、呼气末二氧化碳浓度(PET CO2)、拔管时间及PACU滞留时间、拔管后的呛咳评分、PACU内的镇静镇痛评分及芬太尼的补救量、不良事件的发生情况.结果与T0比较,两组T1 ～ T5心率、MAP下降(P＜0.05),T6心率、MAP升高,C组明显高于D组(P＜0.05).两组各时点呼吸频率、SpO2、VT和PET CO2的组间比较差异均无统计学意义.D组苏醒期呛咳和躁动发生率(30％和13.3％)均低于C组(66.7％和56.7％,P＜0.05),PACU滞留时间短于C组[(15±6)比(23±19) min,P＜0.05],芬太尼补救量少于C组[(0.8±2.1)比(4.9±6.5) μg,P＜0.05].两组拔管时间、不良事件发生率比较差异均无统计学意义(均P ＞0.05).结论单次静注右美托咪定可有效减少苏醒期躁动及呛咳发生,提高唇腭裂患儿七氟烷麻醉苏醒期的质量.
목적 평개단차정주우미탁미정대보류자주호흡칠불완마취진악렬환인소성기적영향.방법 선택2013년10-12월간재온주의과대학부속제이의원택기선천성진악렬수보술환인60례,수궤수자표법분위우미탁미정조(D조)화대조조(C조),매조30례.칠불미전빙흡입마취유도화유지,술중보류자주호흡.D조우수술결속전30 min정맥빙주우미탁미정0.5μg/kg 10 min,C조빙입등량생리염수.관찰여기록량조환인마취유도전(T0)、우미탁미정급약전(T1)、급약완성시(T2)、급약후5 min(T3)、급약후10 min(T4)、술필(T5)、발관즉각(T6)、입PACU 5 min(T7)、술후1 h(R)적심솔、평균동맥압(MAP)、맥박혈양포화도(SpO2)、호흡빈솔、조기량(VT)、호기말이양화탄농도(PET CO2)、발관시간급PACU체류시간、발관후적창해평분、PACU내적진정진통평분급분태니적보구량、불량사건적발생정황.결과 여T0비교,량조T1 ～ T5심솔、MAP하강(P＜0.05),T6심솔、MAP승고,C조명현고우D조(P＜0.05).량조각시점호흡빈솔、SpO2、VT화PET CO2적조간비교차이균무통계학의의.D조소성기창해화조동발생솔(30％화13.3％)균저우C조(66.7％화56.7％,P＜0.05),PACU체류시간단우C조[(15±6)비(23±19) min,P＜0.05],분태니보구량소우C조[(0.8±2.1)비(4.9±6.5) μg,P＜0.05].량조발관시간、불량사건발생솔비교차이균무통계학의의(균P ＞0.05).결론 단차정주우미탁미정가유효감소소성기조동급창해발생,제고진악렬환인칠불완마취소성기적질량.
Objective To explore the effect of single-dose dexmedetomidine on recovery period after sevoflurane anesthesia with spontaneous respiration in pediatric patients undergoing cleft lip and palate repair.Methods A total of 60 American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ pediatric patients undergoing cleft lip and palate repair from October to December 2013 were randomly divided into groups D and C (n =30 each).Dexmedetomidine 0.5 μg/kg (group D) or an equal volume of normal saline (group C) was ad ministered intravenously over a period of 10 min at 30 min before the end of surgery.Anesthesia was induced and maintained with sevoflurane under spontaneous ventilation.Heart rate,mean arterial pressure (MAP),hemoglobin oxygen saturation (SpO2),respiratory rate,tidal volume (VT) and pressure of end-tidal carbon dioxide (PETCO2) were recorded at the time before induction (T0),30 min before the end of surgery (T1),20 min before the end of surgery (T2),15 min before the end of surgery (T3),10 min before the end of surgery (T4),the end of surgery (T5),extubation (T6),5 min after transferal into post-anesthesia care unit (PACU) (T7),1 h after surgery (T8),extubation time,length of PACU stay,fentanyl consumption and adverse events were all recorded.The incidence and severity of coughing and emergence agitation were assessed.Results Compared to T0,MAP and heart rate at T1 to T5 all decreased in two groups (P ＜ 0.05).MAP and heart rate at T6 both increased in two groups and group C was higher than group D (P ＜0.05).No inter-group differences existed in SpO2,respiratory rate,VT or PETCO2.The incidence of coughing and emergence agitation (30％ and 13.3％),fentanyl consumption of group D (0.8 ±2.1 μg) were all significantly lower than that of group C [(66.7％ vs 56.7％) and (4.9 ± 6.50) pg,P＜0.05].Length of PACU stay in group D was shorter than that in group C [(15 ±6) vs (23 ± 19) min,P ＜ 0.05].No inter-group difference existed in extubation time or adverse events.Conclusion A single intravenous dose of dexmedetomidine is effective in reducing emergence agitation and coughing,shortening length of PACU stay and improving the quality of recovery period after sevoflurane anesthesia in pediatric patients undergoing cleft lip and palate repair.