右美托咪定对扁桃体和腺样体摘除术患儿麻醉诱导时的影响

目的探讨右美托咪定对扁桃体腺样体摘除患儿麻醉诱导时的影响。方法选择全身麻醉下行扁桃体腺样体摘除术的患儿40例,年龄4～12岁,体重15～35 kg,ASAⅠ或Ⅱ级,采用随机数字表法将患儿分为两组,右美托咪定组（D组,n=20）和对照组（C组,n=20）;D组患儿在麻醉诱导前10 min给予右美托咪定0.3μg/kg,C组则输入林格液。采用8%七氟烷吸入和6 L/min的氧流量进行麻醉诱导,待患儿睡着后插入气管导管并行机械通气,然后给予顺式阿曲库铵0.2 mg/kg,手术开始前用芬太尼3μg/kg。麻醉维持采用2%～3%七氟烷。记录患儿入室后右美托咪定注射前（T0）、注射后5 min（T1）、注射后10 min（T2）、插管前（T3）、插管时（T4）、插管后3 min（T5）、插管后5 min（T6）的收缩压（SBP）、舒张压（DBP）、心率（HR）、脉搏血氧饱和度（SpO2）和呼吸频率（R）。结果与C组比较,D组SBP、DBP和HR在T4～6时点明显较低（P〈0.05）。D组SBP和DBP在T4～6时点明显低于T0时点（P〈0.05）;C组SBP T4～5时点、DBP T4时点及HR T4～6时点明显高于T0时点（P〈0.05）。C组插管时有3例患儿出现呛咳和躁动反应,而D组所有患儿均无呛咳和躁动反应。结论右美托咪定0.3μg/kg可为扁桃体腺样体摘除术患儿全麻诱导提供良好的镇静,并能较好地抑制插管反应。

Effect of Dexmedetomidine on induction of anesthesia in children undergoing tonsil and adenoid enucleation

Objective To investigate the effect of Dexmedetomidine on induction of anesthesia in children undergoing tonsil and adenoid enucleation.Methods Forty ASA physical status Ⅰ or Ⅱchildren,aged 4-12 years,weighing 1535 kg,scheduled for elective tonsil and adenoid enucleation under general anesthesia,were randomly divided into 2 groups（n = 20 in each group） ： Dexmedetomidine group（group D） and control group（group C）.Dexmedetomidine of 0.3 μg/kg was infused intravenously in 10 min before anesthesia induction in group D,while equal volume of nor mal ringer solution was infused in group C.Anesthesia was induced with inhalation of 8 % sevoflurane and oxygen volume 6 L/min.Tracheal intubation and mechanical ventilation were performed after children fall asleep,then Cisatracurium of 0.2 mg/kg was administered intravenously.Fentanyl of 3 μg/kg was administered before surgery was started.Anesthesia was maintained with inhalation of 2%-3% sevoflurane.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）,peripheral oxygen saturation（SpO2） and respiratory rate（R） were monitored and recorded at time before Dexmedetomidine infusion before（T0）,5 min after infusion（T1）,10 min after infusion（T2）,before intubation（T3）,intubation immediately（T4）,3 min after intubation（T5）,5 min after intubation（T6）.Results Compared with group C,SBP,DBP and HR at T4-6in group D were significantly decreased（P 0.05）.SBP and DBP at T4-6 were lower than T0in group D（P 0.05）.Compared with T0in group C,SBP at T4-5,DBP at T4 and HR at T4-6 were significantly increased（P 0.05）.There were 3 cases of bucking and agitation during tracheal intubation in group C,but none in group D.Conclusion Dexmedetomidine of 0.3 μg/kg can provide good sedative effect and inhibit the reaction of tracheal intubation better during tonsil and adenoid enucleation under general anesthesia.