摘要
目的探讨右美托咪陡抑制学龄前儿童全麻下行扁桃体切除术后苏醒期躁动(EA)的量效关系。方法择期行扁桃体切除术的学龄前儿童80例,按随机数字表法分为静脉组(丙泊酚-瑞芬维持,n=40)和吸入组(七氟醚维持,n=40)。按点斜法要求,静脉组、吸入组均随机分为5个剂量组,诱导后泵注右美托咪啶,剂量呈等比数列。记录每例患儿术后躁动情况、不良反应、疼痛评分以及术后行为改变情况。结果右美托咪啶抑制静脉组和吸入组EA的ED_(50)分别为0.28μg/(kg·h)和0.34μg/(kg·h)。躁动患儿与非躁动患儿的麻醉复苏室(PACU)停留时间和疼痛发生率比较差异有统计学意义(P<0.05);术后行为改变的发生率组间差异无统计学意义(P>0.05)。在ED_(50)的95%可信限范围内无不良反应。结论右美托咪啶抑制丙泊酚-瑞芬麻醉后和七氟醚麻醉后EA的ED_(50)为0.28(0.22～0.35)μg/(kg·h)、0.34(0.27～0.43)μg/(kg·h),在该剂量范围内安全可靠。
Objective To evaluate the effective dose of dexmedetomidine （DEX） for prevention of emergence agitation （EA） after total intravenous anesthesia or sevoflurane anesthesia for preschool children undergoing a tonsillectomy. Methods 80 preschool children undergoing a selective tonsillectomy were ran- domly divided into 2 groups ： intravenous group （ total intravenous anesthesia, n = 40 ） and inhalation group （ sevoflurane inhaled anesthesias, n = 40）. According to the spot-slope method, intravenous group and inha- lation group were randomly divided into 5 dose groups and given DEX in a geometric progression after induction. The EA, adverse effects,the pain score and the postoperative behavioral outcomes of each child in the two groups were recorded. Results The EDs0 s for prevention of EA were 0. 28 p,g/（ kg·h） in intravenous group and 0. 34 μg/（ kg · h） in inhalation group. The duration of children＇s staying post-anesthesia care unit （PACU） and the incidence of pain were significantly greater in those with EA than those without （P 〈 0.05 ） , and the incidence of the postoperative behavioral outcomes were not statically different （ P 〉 0.05 ）. No severe adverse reactions were observed in 95% confidence limits. Conclusions 0. 28 （0. 22 - 0. 35） μg/（ kg·h） and 0. 34 （0. 27 - 0. 43 ） μg/（ kg·h） of DEX are safe and reliable for prevention of EA after intravenous anesthesia and sevoflurane anesthesia for preschool children undergoing a tonsillectomy.
作者
张丹凤
李茹
严海雅
吕欣
Zhang Danfeng;Li Ru;Yan Haiya;Lyu Xin(Department of Anesthesiology, Pulmonary Hospital, Tongji University, Shanghai 200433, China;Department of Anesthesiology, Ningbo Women and Children＇s Hospital, Ningbo 315010, China)
出处
《中国医师杂志》
CAS
2018年第4期502-506,共5页
Journal of Chinese Physician
