中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2015年
2期
227-230
,共4页
周密%张明瑜%许晓东%张琼%舒爱华
週密%張明瑜%許曉東%張瓊%舒愛華
주밀%장명유%허효동%장경%서애화
瑞芬太尼%右美托咪定%麻醉,静脉%拔管反应%躁动
瑞芬太尼%右美託咪定%痳醉,靜脈%拔管反應%躁動
서분태니%우미탁미정%마취,정맥%발관반응%조동
Remifentanil%Dexmedetomidine%Anesthesia,intravenous%Extubation response%Emergence delirium
目的：观察靶控输注瑞芬太尼与恒速输注右美托咪定对小儿全凭静脉麻醉苏醒期拔管反应及躁动的影响。方法将90例择期全凭静脉麻醉下行扁桃体腺样体切除术患儿，随机分为对照组（C组）、瑞芬太尼组（R组）和右美托咪定（D组）。麻醉诱导后D组静脉持续输注右美托咪定0.3μg·k g-1·h-1直至气管导管拔出。手术结束前2 min，C组和D组停用异丙酚和瑞芬太尼；R组停用异丙酚，将瑞芬太尼的T CI浓度调整为1.5 ng/ml直至气管导管拔出。记录泵注右美托咪定前（T 0）、手术结束时（T1）、拔管前1 min（T2）、拔管时（T3）和拔管后1 min（T4）、5 min（T5）、10 min （T6）的平均动脉压（M AP）、心率（HR）；记录停用异丙酚至拔管时间、睁眼时间、拔管时呛咳反应评分；根据儿童麻醉后躁动评分（ PA ED ）和改良加拿大东安大略儿童医院疼痛评分量表（m-CH EOP S），拔管后每5 min对患儿进行躁动和疼痛评分，记录所得最高值作为监测有效值。结果与T0时比较，C组T2～T6时、R组T5～T6时MAP和HR均显著升高（P＜0.05），D组各时点MAP与HR差异无统计学意义；与C组比较，R组T2～T4时、D组T2～T6时MAP与HR均较低（P＜0.05）；与R组比较，D组T5～T6时MAP与HR较低（P＜0.05）。三组患儿拔管时间、睁眼时间比较差异无统计学意义（P＞0.05）；拔管时呛咳反应评分R组与D组显著低于C组（P＜0.05），PAED评分和疼痛评分D组显著低于C组（P＜0.05）与R组（P＜0.05）。结论靶控输注瑞芬太尼（1.5 ng/ml）与恒速输注右美托咪定（0.3μg·k g-1·h-1），均能有效抑制小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期的拔管反应，且不延长麻醉苏醒时间。恒速输注右美托咪定还能减少患儿术后躁动的发生，更适用于小儿全麻苏醒期。
目的：觀察靶控輸註瑞芬太尼與恆速輸註右美託咪定對小兒全憑靜脈痳醉囌醒期拔管反應及躁動的影響。方法將90例擇期全憑靜脈痳醉下行扁桃體腺樣體切除術患兒，隨機分為對照組（C組）、瑞芬太尼組（R組）和右美託咪定（D組）。痳醉誘導後D組靜脈持續輸註右美託咪定0.3μg·k g-1·h-1直至氣管導管拔齣。手術結束前2 min，C組和D組停用異丙酚和瑞芬太尼；R組停用異丙酚，將瑞芬太尼的T CI濃度調整為1.5 ng/ml直至氣管導管拔齣。記錄泵註右美託咪定前（T 0）、手術結束時（T1）、拔管前1 min（T2）、拔管時（T3）和拔管後1 min（T4）、5 min（T5）、10 min （T6）的平均動脈壓（M AP）、心率（HR）；記錄停用異丙酚至拔管時間、睜眼時間、拔管時嗆咳反應評分；根據兒童痳醉後躁動評分（ PA ED ）和改良加拿大東安大略兒童醫院疼痛評分量錶（m-CH EOP S），拔管後每5 min對患兒進行躁動和疼痛評分，記錄所得最高值作為鑑測有效值。結果與T0時比較，C組T2～T6時、R組T5～T6時MAP和HR均顯著升高（P＜0.05），D組各時點MAP與HR差異無統計學意義；與C組比較，R組T2～T4時、D組T2～T6時MAP與HR均較低（P＜0.05）；與R組比較，D組T5～T6時MAP與HR較低（P＜0.05）。三組患兒拔管時間、睜眼時間比較差異無統計學意義（P＞0.05）；拔管時嗆咳反應評分R組與D組顯著低于C組（P＜0.05），PAED評分和疼痛評分D組顯著低于C組（P＜0.05）與R組（P＜0.05）。結論靶控輸註瑞芬太尼（1.5 ng/ml）與恆速輸註右美託咪定（0.3μg·k g-1·h-1），均能有效抑製小兒扁桃體腺樣體切除術全憑靜脈痳醉囌醒期的拔管反應，且不延長痳醉囌醒時間。恆速輸註右美託咪定還能減少患兒術後躁動的髮生，更適用于小兒全痳囌醒期。
목적：관찰파공수주서분태니여항속수주우미탁미정대소인전빙정맥마취소성기발관반응급조동적영향。방법장90례택기전빙정맥마취하행편도체선양체절제술환인，수궤분위대조조（C조）、서분태니조（R조）화우미탁미정（D조）。마취유도후D조정맥지속수주우미탁미정0.3μg·k g-1·h-1직지기관도관발출。수술결속전2 min，C조화D조정용이병분화서분태니；R조정용이병분，장서분태니적T CI농도조정위1.5 ng/ml직지기관도관발출。기록빙주우미탁미정전（T 0）、수술결속시（T1）、발관전1 min（T2）、발관시（T3）화발관후1 min（T4）、5 min（T5）、10 min （T6）적평균동맥압（M AP）、심솔（HR）；기록정용이병분지발관시간、정안시간、발관시창해반응평분；근거인동마취후조동평분（ PA ED ）화개량가나대동안대략인동의원동통평분량표（m-CH EOP S），발관후매5 min대환인진행조동화동통평분，기록소득최고치작위감측유효치。결과여T0시비교，C조T2～T6시、R조T5～T6시MAP화HR균현저승고（P＜0.05），D조각시점MAP여HR차이무통계학의의；여C조비교，R조T2～T4시、D조T2～T6시MAP여HR균교저（P＜0.05）；여R조비교，D조T5～T6시MAP여HR교저（P＜0.05）。삼조환인발관시간、정안시간비교차이무통계학의의（P＞0.05）；발관시창해반응평분R조여D조현저저우C조（P＜0.05），PAED평분화동통평분D조현저저우C조（P＜0.05）여R조（P＜0.05）。결론파공수주서분태니（1.5 ng/ml）여항속수주우미탁미정（0.3μg·k g-1·h-1），균능유효억제소인편도체선양체절제술전빙정맥마취소성기적발관반응，차불연장마취소성시간。항속수주우미탁미정환능감소환인술후조동적발생，경괄용우소인전마소성기。
Objective To observe the effects of target controlled infusion of remifentanil and constant infusion of dexmedetomidine on extubation response and emergence delirium during emergence from total intravenous anesthesia (TIVA) for pediatric patients. Methods 90 children undergoing adenotonsillectomy under TIVA were randomly divided into control group (group C) , remifentanil (group R) and dexmedetomidine group (group D). Dexmedetomidine was infused at the rate of 0.3μg·kg-1·h-1 in group D until extubation after anesthesia induction. At 2 minutes before the end of the surgery, propofol was ceased and infusion of remifentanil was stopped in group C and group D and maintained in group R at target organ concentration of 1.5 ng/ml until extubation. Mean artery pressure (MAP) and heart rate (HR) were recorded before Dex delivery (T0), the end of the surgery (T1), 1 min (T2) before extubation, during extubation (T3) and 1 (T4), 5 (T5), 10 min (T6) after extubation. Time from stopping propofol to extubation and opening eyes and cough reflex score during extubation were recorded. According to the Pediatric Anesthesia Emergence Delirium to mark the delirium of the patient per 5 minutes after extubation, the highest score was used to effective value, and at the same time, mark the degree of pain according to the modified Children’s Hospital of Eastern Ontario Pain Scale. Results Compared with T0, MAP and HR at T2-T6 in group C and at T5-T6 in group R were significantly higher (P<0.05), at each time point in group D were no significant difference (P>0.05). Compared with group C , MAP and HR at T2-T4 in group R and T2-T6 in group D were significantly lower (P<0.05). Compared with group R, MAP and HR at T5-T6 in group D were significantly lower (P<0.05). There was no significant difference in extubation time and opening eyes time between the three groups (P>0.05). Cough reflex score of group R and group D was significantly lower than group C (P<0.05), PAED and pain score of group D was significantly lower than group C (P<0.05) and group R (P<0.05). Conclusion Target controlled infusion of remifentanil (1.5 ng/ml) and continuous infusion of dexmedetomidine (0.3 μg·kg-1·h-1) can effectively inhibit extubation response and don’t increase the postoperative recovery time in pediatric adenotonsillectomy under TIVA. While continuous infusion of dexmedetomidine can decrease the incidence rate of emergence delirium, more applicable to infusion during emergence from TIVA for pediatric patients.
