摘要
目的探讨右美托咪定(dexmedetomidine,Dex)复合氯胺酮用于阻塞型睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患儿行药物诱导睡眠气道镜检查(drug-induced sleep endoscopy,DISE)的效果及副作用。方法OSAS患儿70例,年龄3~12岁,ASA分级Ⅰ、Ⅱ级,性别不限,按随机数字表法分为A组和B组,每组35例。两组患儿在10 min内静脉输注Dex负荷剂量2μg/kg,再以1μg·kg^(-1)·h^(-1)静脉输注维持。A组在开始静脉注射Dex时即追加氯胺酮1 mg/kg,B组则在静脉注射Dex 5 min时追加氯胺酮1 mg/kg。所有患儿Ramsay评分>5分后开始检查。记录患儿检查一次性成功率,记录患儿清醒状态(T_(0))、输注Dex负荷剂量5 min(T_(1))、输注Dex负荷剂量10 min(T_(2))、检查时(T_(3))的生命体征,记录患儿因体动而追加氯胺酮的情况和用药后不良事件。结果B组检查一次性成功率高于A组(P<0.05)。B组患儿T_(2)时SpO_(2)低于A组,T_(1)时心率、DBP、SBP低于A组,差异有统计学意义(P<0.05)。A组患儿T_(1)、T_(2)、T_(3)时SpO_(2)、心率均较T_(0)降低(P<0.05),SBP、DBP较T_(0)升高(P<0.05);T_(2)、T_(3)时心率较T_(1)时降低(P<0.05);T_(3)时SpO_(2)较T_(2)时降低(P<0.05)。B组患儿T_(1)、T_(2)、T_(3)时SpO_(2)、心率较T_(0)下降(P<0.05);T_(1)时SBP较T_(0)降低(P<0.05),T_(2)时SBP较T_(0)升高(P<0.05),T_(2)、T_(3)时DBP较T_(0)升高(P<0.05);T_(2)、T_(3)时SpO_(2)较T_(1)时下降(P<0.05),心率、SBP较T_(1)时升高(P<0.05);T_(2)时DBP较T_(1)时升高(P<0.05),T_(3)时DBP较T_(2)时降低(P<0.05)。两组患儿不良事件发生情况差异无统计学意义(P<0.05)。B组中1例心动过缓患儿静脉注射阿托品后好转,1例患儿在T_(1)时发生3∶2和4∶3二度房室阻滞,静脉注射氯胺酮后消失。结论Dex复合氯胺酮同步给药较先后给药对OSAS患儿缺氧和血流动力学影响更轻,未发生严重的心动过缓和低血压,是OSAS患儿行DISE时合适的麻醉方案。
Objective To discuss the effectiveness and side effects of dexmedetomidine(Dex)combined with ketamine for drug⁃induced sleep endoscopy(DISE)in children with obstructive sleep apnea syndrome(OSAS).Methods According to the ran⁃dom number table method,70 OSAS children,aged 3 to 12 years,American Society of Anesthesiologists(ASA)ⅠorⅡ,both boys and girls,were divided into two groups(n=35):group A and group B.All the children were intravenously infused with a loading dose of Dex(2μg/kg)over 10 min followed by intravenous infusion at 1μg·kg^(-1)·h^(-1) for anesthesia maintenance.For group A,1 mg/kg ketamine was added at the beginning of Dex injection.For group B,1 mg/kg ketamine was added when Dex was intravenously injected for 5 min.Ex⁃amination started when Ramsay score>5.The first⁃attempt success rate was recorded.The vital signs were recorded before induction(T_(0)),when Dex infusion was performed for 5 min(T_(1))and 10 min(T_(2))and during examination(T_(3)).The addition of ketamine due to body movement and adverse reactions were recorded.Results Group B presented a higher first⁃attempt success rate than group A(P<0.05).Group B produced decreases in pulse oxygen saturation(SpO_(2))at T_(2),decreases in heart rate,diastolic blood pressure(DBP),and systolic blood pressure(SBP)at T_(1),compared with group A(P<0.05).Patients in group A produced decreases in SpO_(2) and heart rate at T_(1),T_(2) and T_(3),compared with those at T_(0)(P<0.05);increases in SBP and DBP at T_(1),T_(2) and T_(3),compared with those at T_(0)(P<0.05);de⁃creases in heart rate at T_(2) and T_(3),compared with those at T_(1)(P<0.05);and decreases in SpO_(2) at T_(3),compared with those at T_(2)(P<0.05).Patients in group B produced decreases in SpO_(2) and heart rate at T_(1),T_(2) and T_(3),compared with those at T_(0)(P<0.05);decreases in SBP at T_(1),compared with those at T_(0)(P<0.05);increases in SBP at T_(2),compared with those at T_(0)(P<0.05);increases in DBP at T_(2) and T_(3),com⁃pared with those at T_(0)(P<0.05);d
作者
张剑蔚
宋蕴安
张瑞冬
白洁
郑吉建
Zhang Jianwei;Song Yun'an;Zhang Ruidong;Bai Jie;Zheng Jijian(Department of Anesthesiology,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)
出处
《国际麻醉学与复苏杂志》
CAS
2021年第2期151-154,共4页
International Journal of Anesthesiology and Resuscitation
基金
上海市科学技术委员会医学引导类(中、西医)科技支撑项目(17411965500)。