右美托咪定联合盐酸纳美芬在小儿喉罩麻醉中的应用
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摘要
目的观察右美托咪定(DEX)联合盐酸纳美芬(NMF)在小儿喉罩麻醉中的应用效果。方法选择80例喉罩全麻下阑尾切除术患儿,随机分成对照组、DEX组、NMF组及DEX联合NMF组(DN组),每组20例。4组均给予常规麻醉,同时DEX组术中持续泵注0. 5μg/(kg·h) DEX,NMF组于手术结束时静脉推注0. 3μg/kg NMF,DN组在DEX组基础上于手术结束时静脉推注0. 3μg/kg NMF。记录4组患儿术前(T_1)、手术结束时(T_2)和拔管时(T_3)的平均动脉压(MAP)、心率、指脉血氧饱和度(SPO_2)及脑电双频指数(BIS)值,比较各组患儿的睁眼时间、自主呼吸恢复时间、拔出喉罩时间及拔出喉罩后的镇静Ramsay评分、婴幼儿术后疼痛量表(CHIPPS)评分、不良反应发生情况。结果 4组的MAP、心率及BIS水平比较,差异均有统计学意义(均P <0. 05),且均有随时间变化的趋势(均P <0. 05)。4组自主呼吸恢复时间、睁眼时间、拔出喉罩时间由低到高均为NMF组 0. 05)。4组患儿拔出喉罩后恶心呕吐、呼吸道痉挛及呼吸抑制发生率比较,差异均无统计学意义(均P> 0. 05)。结论采用DEX联合NMF可缩短小儿喉罩麻醉复苏时间,提高复苏质量,且不增加不良反应。
Objective To observe the efficacy of dexmedetomidine( DEX) combined with nalmefene hydrochloride( NMF) applied to pediatric laryngeal mask anesthesia. Methods Eighty children undergoing appendectomy under laryngeal mask general anesthesia were randomly allocated to control group,DEX group,NMF group or DEX combined with NMF group( DN group),with 20 cases in each group. All four groups received routine anesthesia,with additionally,DEX group receiving continuous pump infusion of 0. 5 μg/( kg·h) DEX during operation,NMF group receiving intravenous push of 0. 3 μg/kg NMF at the end of operation,and DN group receiving both. The mean arterial pressure( MAP),heart rate,pulse oxygen saturation( SpO_2) and bispectral index( BIS) of the four groups were recorded before operation( T_1),at the end of operation( T_2) and at extubation( T_3). The duration for analepsia,return of spontaneous respiration and laryngeal mask removal,and the indices after laryngeal mask removal[including Ramsay score for sedation,the score of children's and infants postoperative pain scale( CHIPPS) and the occurrence of adverse reactions] were compared among the four groups. Results There were significant differences in the MAP,heart rate and BIS levels between the four groups( all P < 0. 05),and the indices above all trended to change with the time( all P < 0. 05). The duration for analepsia,return of spontaneous breathing and laryngeal mask removal increased in the sequence of NMF group,DN group,control group and DEX group( all P < 0. 05). The Ramsay score for sedation increased,and the CHIPPS score decreased in the sequence of control group/NMF group,DN group and DEX group( all P < 0. 05),with no significant differences between the control group and NMF group( P > 0. 05). There was no significant difference in the incidence of nausea,vomiting,respiratory spasm,or respiratory depression after laryngeal mask removal among the four groups( all P > 0. 05). Conclusion DEX combined with NMF can shorten recovery duration of laryngeal mask anesthesia,and improve quality of recovery without increasing adverse reactions in children.
Objective To observe the efficacy of dexmedetomidine( DEX) combined with nalmefene hydrochloride( NMF) applied to pediatric laryngeal mask anesthesia. Methods Eighty children undergoing appendectomy under laryngeal mask general anesthesia were randomly allocated to control group,DEX group,NMF group or DEX combined with NMF group( DN group),with 20 cases in each group. All four groups received routine anesthesia,with additionally,DEX group receiving continuous pump infusion of 0. 5 μg/( kg·h) DEX during operation,NMF group receiving intravenous push of 0. 3 μg/kg NMF at the end of operation,and DN group receiving both. The mean arterial pressure( MAP),heart rate,pulse oxygen saturation( SpO_2) and bispectral index( BIS) of the four groups were recorded before operation( T_1),at the end of operation( T_2) and at extubation( T_3). The duration for analepsia,return of spontaneous respiration and laryngeal mask removal,and the indices after laryngeal mask removal[including Ramsay score for sedation,the score of children's and infants postoperative pain scale( CHIPPS) and the occurrence of adverse reactions] were compared among the four groups. Results There were significant differences in the MAP,heart rate and BIS levels between the four groups( all P < 0. 05),and the indices above all trended to change with the time( all P < 0. 05). The duration for analepsia,return of spontaneous breathing and laryngeal mask removal increased in the sequence of NMF group,DN group,control group and DEX group( all P < 0. 05). The Ramsay score for sedation increased,and the CHIPPS score decreased in the sequence of control group/NMF group,DN group and DEX group( all P < 0. 05),with no significant differences between the control group and NMF group( P > 0. 05). There was no significant difference in the incidence of nausea,vomiting,respiratory spasm,or respiratory depression after laryngeal mask removal among the four groups( all P > 0. 05). Conclusion DEX combined with NMF can shorten recovery duration of laryngeal mask anesthesia,and improve quality of recovery without increasing adverse reactions in children.
引文
[1]张加强,孟凡民.右美托咪定对七氟醚麻醉诱导时患者躁动及应激反应的影响[J].临床麻醉学杂志,2013,29(2):194-195.
[2]邱永升,贾英萍,徐庆.右美托咪定滴鼻复合丙泊酚静脉注射用于小儿无痛结肠镜诊疗的临床研究[J].中华消化内镜杂志,2015,32(5):308-312.
[3]罗小伟,钟云川,李成.静脉输注右美托咪定对小儿全身麻醉苏醒期躁动的预防效果[J].中国急救医学,2017,37(z2):5-6.
[4]韦祎,扈俊华,梁羽冰,等.右美托咪定对胎鼠离体海马神经元磷酸化CREB表达的影响[J].中华麻醉学杂志,2014,34(11):1 309-1 311.
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[7]王金鑫,史淑珍,李菊红,等.右美托咪定复合七氟烷麻醉在小儿烧伤短小手术中的应用效果观察[J].解放军医学杂志,2016,41(3):254-257.
[8]任爱国,苏俊峰.纳美芬对急性乙醇中毒的实验治疗[J].解放军医学杂志,2000,25(6):449-450.
[9]王洪亮,于凯江,刘海涛.纳美芬治疗感染性休克的临床疗效观察[J].中国危重病急救医学,2010,22(6):351-353.
[10]张雷.盐酸纳美芬联合醒脑静注射液对急性安眠药中毒抢救患者疗效及生活质量的影响[J].中国地方病防治杂志,2017,32(5):572.
[11]孙晶,李小平,王婷婷,等.纳美芬改善大面积脑梗死预后:随机对照前瞻性临床试验方案[J].中国组织工程研究,2017,21(36):5 835-5 840.
[12]王小雪,吕红,张建敏.盐酸纳美芬在小儿复合麻醉中的应用[J].临床小儿外科杂志,2015,14(6):552-554.
[13]姜燕,魏嵘,傅月珍.盐酸纳美芬在小儿喉罩麻醉中的应用[J].上海交通大学学报(医学版),2018,38(2):192-194.
[14]中华医学会外科学分会.加速康复外科中国专家共识暨路径管理指南(2018)[J].中华麻醉学杂志,2018,38(1):8-13.
[15]杨静,吴友平,屠伟峰.肠手术中右美托咪定保护作用的研究进展[J].临床麻醉学杂志,2018,34(1):92-94.
[16]刘莹,邵军进,孙大新.地氟烷复合右美托咪定对不停跳冠状动脉搭桥术(OPCABG)患者的疗效分析[J].中国临床药理学与治疗学,2018,23(4):440-445.
[17]静广建,王耀岐,王颖,等.右美托咪定两种给药方式在妇科腹腔镜手术中的麻醉效果观察[J].山东医药,2013,53(47):40-42.
[18]叶玉萍,刘涌,李水英,等.不同剂量右美托咪定复合丙泊酚用于学龄前儿童全麻肠镜检查的临床观察[J].实用医学杂志,2018,34(11):1 907-1 910.
[19]曾伟,刘克玄.右美托咪定在小儿腹腔镜下内环口缝扎术中的最佳剂量[J].广东医学,2017,38(9):1 429-1 432.
[20]朴连玉,冯雅珍,李飞,等.右美托咪啶及小剂量氯胺酮预防小儿全麻苏醒期躁动的对比观察[J].中国妇幼保健,2013,28(4):696-698.
[21]李立晶,张建敏,辛忠,等.纳美芬在小儿腺样体扁桃体切除术中的应用[J].中国医药导刊,2014,16(12):1 481-1 482,1 484.
[22]Wu Q,Chen X,Wang J,et al. Nalmefene attenuates malignant potential in colorectal cancer cell via inhibition of opioid receptor[J]. Acta Biochim Biophys Sin(Shanghai),2018,50(2):156-163.
[23]武栋,程斌,高茂龙,等.小剂量纳美芬在老年髋部骨折患者术后静脉自控镇痛中的应用[J].首都医科大学学报,2016,37(2):241-244.
[24]张国生,崔丹,孟凡民,等.盐酸纳美芬对60例腹腔镜胆囊切除术患者全麻超前镇痛效果的观察[J].第三军医大学学报,2010,32(11):1 239-1 240.
[25]张永,高培龙,褚沛,等.盐酸纳美芬对大鼠创伤性脑损伤后炎症反应的影响[J].中华创伤杂志,2013,29(10):991-995.
[26]易利丹,彭六保,谭重庆,等.新型镇静镇痛药——右美托咪定[J].中国新药与临床杂志,2011,30(1):5-10.
[2]邱永升,贾英萍,徐庆.右美托咪定滴鼻复合丙泊酚静脉注射用于小儿无痛结肠镜诊疗的临床研究[J].中华消化内镜杂志,2015,32(5):308-312.
[3]罗小伟,钟云川,李成.静脉输注右美托咪定对小儿全身麻醉苏醒期躁动的预防效果[J].中国急救医学,2017,37(z2):5-6.
[4]韦祎,扈俊华,梁羽冰,等.右美托咪定对胎鼠离体海马神经元磷酸化CREB表达的影响[J].中华麻醉学杂志,2014,34(11):1 309-1 311.
[5]Kang Z,Xie W,Xie W,et al. Comparison of neurotoxicity of dexmedetomidine as an adjuvant in brachial plexus block in rats of different age[J]. Neurotoxicol Teratol,2018,69:21-26.
[6]沈婷,王英伟.右美托咪定持续输注对小儿全麻术后躁动的影响[J].国际麻醉学与复苏杂志,2013,34(11):965-969.
[7]王金鑫,史淑珍,李菊红,等.右美托咪定复合七氟烷麻醉在小儿烧伤短小手术中的应用效果观察[J].解放军医学杂志,2016,41(3):254-257.
[8]任爱国,苏俊峰.纳美芬对急性乙醇中毒的实验治疗[J].解放军医学杂志,2000,25(6):449-450.
[9]王洪亮,于凯江,刘海涛.纳美芬治疗感染性休克的临床疗效观察[J].中国危重病急救医学,2010,22(6):351-353.
[10]张雷.盐酸纳美芬联合醒脑静注射液对急性安眠药中毒抢救患者疗效及生活质量的影响[J].中国地方病防治杂志,2017,32(5):572.
[11]孙晶,李小平,王婷婷,等.纳美芬改善大面积脑梗死预后:随机对照前瞻性临床试验方案[J].中国组织工程研究,2017,21(36):5 835-5 840.
[12]王小雪,吕红,张建敏.盐酸纳美芬在小儿复合麻醉中的应用[J].临床小儿外科杂志,2015,14(6):552-554.
[13]姜燕,魏嵘,傅月珍.盐酸纳美芬在小儿喉罩麻醉中的应用[J].上海交通大学学报(医学版),2018,38(2):192-194.
[14]中华医学会外科学分会.加速康复外科中国专家共识暨路径管理指南(2018)[J].中华麻醉学杂志,2018,38(1):8-13.
[15]杨静,吴友平,屠伟峰.肠手术中右美托咪定保护作用的研究进展[J].临床麻醉学杂志,2018,34(1):92-94.
[16]刘莹,邵军进,孙大新.地氟烷复合右美托咪定对不停跳冠状动脉搭桥术(OPCABG)患者的疗效分析[J].中国临床药理学与治疗学,2018,23(4):440-445.
[17]静广建,王耀岐,王颖,等.右美托咪定两种给药方式在妇科腹腔镜手术中的麻醉效果观察[J].山东医药,2013,53(47):40-42.
[18]叶玉萍,刘涌,李水英,等.不同剂量右美托咪定复合丙泊酚用于学龄前儿童全麻肠镜检查的临床观察[J].实用医学杂志,2018,34(11):1 907-1 910.
[19]曾伟,刘克玄.右美托咪定在小儿腹腔镜下内环口缝扎术中的最佳剂量[J].广东医学,2017,38(9):1 429-1 432.
[20]朴连玉,冯雅珍,李飞,等.右美托咪啶及小剂量氯胺酮预防小儿全麻苏醒期躁动的对比观察[J].中国妇幼保健,2013,28(4):696-698.
[21]李立晶,张建敏,辛忠,等.纳美芬在小儿腺样体扁桃体切除术中的应用[J].中国医药导刊,2014,16(12):1 481-1 482,1 484.
[22]Wu Q,Chen X,Wang J,et al. Nalmefene attenuates malignant potential in colorectal cancer cell via inhibition of opioid receptor[J]. Acta Biochim Biophys Sin(Shanghai),2018,50(2):156-163.
[23]武栋,程斌,高茂龙,等.小剂量纳美芬在老年髋部骨折患者术后静脉自控镇痛中的应用[J].首都医科大学学报,2016,37(2):241-244.
[24]张国生,崔丹,孟凡民,等.盐酸纳美芬对60例腹腔镜胆囊切除术患者全麻超前镇痛效果的观察[J].第三军医大学学报,2010,32(11):1 239-1 240.
[25]张永,高培龙,褚沛,等.盐酸纳美芬对大鼠创伤性脑损伤后炎症反应的影响[J].中华创伤杂志,2013,29(10):991-995.
[26]易利丹,彭六保,谭重庆,等.新型镇静镇痛药——右美托咪定[J].中国新药与临床杂志,2011,30(1):5-10.