CAJ | 학술논문

目的观察右美托嘧啶在预防小儿Nuss手术苏醒期躁动的效果.方法60例接受Nuss手术的患儿,随机分为右美托嘧啶组(D组)和生理盐水组(N组),采用七氟烷吸入诱导,静脉推注瑞芬太尼2μg?kg-1、顺式阿曲库铵0.15 mg?kg-1,D组给予右美托嘧啶1μg?kg-1,待BIS为60时行气管插管.术中右美托嘧啶维持速度为0.2μg?kg-1?h-1,手术结束前5 min停止输注;N组静注生理盐水.手术结束后所有患儿均拔管,接镇痛泵送入恢复室观察2 h.记录患儿的手术时间,停药至清醒时间,右美托嘧啶注入前(T1)、注射后5 min(T2)、10 min(T3)、患儿清醒时(T4)、拔管后1 min(T5)、拔管后10 min(T6)、拔管后30 min(T7)的MAP、HR、SPO2及烦躁评分,记录躁动时间大于10 min的发生率.结果 D组与N组比较,T4~T6时的D组MAP明显降低,HR明显减慢(P<0.05);D组4例(13%)、N组21例(70%)有躁动,N组明显高于D组(P<0.01),N组所需要PCA次数明显高于D组(P<0.01).结论在小儿Nuss手术麻醉苏醒期右美托咪啶可以产生镇静、镇痛和抗焦虑作用,明显减少麻醉后疼痛、躁动及血流动力学变化,且不增加不良反应.
목적관찰우미탁밀정재예방소인Nuss수술소성기조동적효과.방법60례접수Nuss수술적환인,수궤분위우미탁밀정조(D조)화생리염수조(N조),채용칠불완흡입유도,정맥추주서분태니2μg?kg-1、순식아곡고안0.15 mg?kg-1,D조급여우미탁밀정1μg?kg-1,대BIS위60시행기관삽관.술중우미탁밀정유지속도위0.2μg?kg-1?h-1,수술결속전5 min정지수주;N조정주생리염수.수술결속후소유환인균발관,접진통빙송입회복실관찰2 h.기록환인적수술시간,정약지청성시간,우미탁밀정주입전(T1)、주사후5 min(T2)、10 min(T3)、환인청성시(T4)、발관후1 min(T5)、발관후10 min(T6)、발관후30 min(T7)적MAP、HR、SPO2급번조평분,기록조동시간대우10 min적발생솔.결과 D조여N조비교,T4~T6시적D조MAP명현강저,HR명현감만(P<0.05);D조4례(13%)、N조21례(70%)유조동,N조명현고우D조(P<0.01),N조소수요PCA차수명현고우D조(P<0.01).결론재소인Nuss수술마취소성기우미탁미정가이산생진정、진통화항초필작용,명현감소마취후동통、조동급혈류동역학변화,차불증가불량반응.
Objective To observe Dexmedetomidine in the prevention of pediatric Nuss operation restlessness effect.Methods 60 patients underwent Nuss operation were randomly divided into Dexmedetomidine group ( D group) and Normal saline group ( N group ), with sevoflurane inhalation induction, intravenous remifentanil 2μg?kg-1,cisatracurium 0.15 mg?kg-1, D group was given the right search pyrimidine 1μg?kg-1, when the tracheal intubation the BIS is 60. Dexmedetomidine speed is 0.2μg?kg-1?h-1, 5 min operation before the end of the infusion was stopped;group N intravenous saline. After the operation all patients were extubated, analgesia pump into the recovery room observation 2 h. Recording with operation time, stopping time to awake, the right search pyrimidine injected into the anterior (T1), after injection of 5 min ( T2 ), 10 min ( T3 ), children awake (T4), 1 min after extubation ( T5 ), 10 min after extubation ( T6 ), 30 min after extubation ( T7 ). MAP, HR, SpO2 and irritability score, recording time is greater than the rate of 10 min restlessness. Results Compare D group with N group, T4~T6 group D MAP were significantly decreased, HR was decreased (P<0.05 );4 cases in D group (13%), 21 cases in N group ( 70%) a restless, was higher in group N than in group D ( P<0.01 ), N group required significantly higher than that in D group PCA number(P<0.01 ).Conclusion Nuss operation in pediatric anesthesia analepsia period of dexmedetomidine can produce sedative, analgesic and anxiolytic effects, decreased significantly after anesthesia pain, agitation and hemodynamic changes, and no increase in adverse reaction.