右美托咪定滴鼻应用于小儿全身麻醉对苏醒期躁动的影响
摘要
目的观察不同剂量右美托咪定滴鼻应用于小儿全身麻醉对苏醒期躁动的影响。方法将需行手术治疗的小儿300例随机分为A、B、C 3组,每组100例。A组、B组、C组分别于术前30 min给予0.5μg/kg、1μg/kg的右美托咪定、0.4 mL生理盐水,均给予等剂量芬太尼、咪达唑仑、丙泊酚、顺-阿曲库铵行麻醉诱导,术中给予七氟烷吸入、间断静注芬太尼及顺-阿曲库铵维持脑电双频指数(BIS)于40～60之间,术毕前10 min停止七氟烷吸入。比较3组滴鼻前、滴鼻后30 min、拔管时、拔管后10 min OAA/S评分;记录3组拔管时间、离开恢复室时间;统计3组不良反应发生率。结果与C组比较,A、B组滴鼻后30 min、拔管时、拔管后10 min OAA/S评分均更低(P均<0.05),且B组明显低于A组(P均<0.05);3组患儿拔管时间、离开恢复室时间比较差异均无统计学意义(P均>0.05);与C组比较,A组、B组不良反应发生率均降低,且A组、B组心动过速、高血压、躁动发生率均明显低于C组(P均<0.05)。结论术前30 min右美托咪定1μg/kg滴鼻应用于小儿全身麻醉可降低苏醒期躁动发生率,镇静效果更优,且不增加不良反应发生率,临床应用安全。
引文
[1] 金约西,姜爱芬,姜婉娜,等. 不同剂量右美托咪啶用于小儿全身麻醉苏醒期躁动的临床观察[J]. 中国药物与临床,2013,13(5):673-675
[2] 张瑛,钟文晖,王爱忠,等. 右美托咪定对缺血-再灌注大鼠肠黏膜屏障功能的影响[J]. 上海交通大学学报:医学版,2014,34(4):487-490;506
[3] Ohshima T,Miyachi S,Takahashi I,et al. Assessment of endovascular coil configuration for embolization of intracranial aneurysms using computational fluid dynamics[J]. Nagoya J Med Sci,2015,77(3):383-388
[4] Chen JX,Lai LF,Zheng K,et al. Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment[J]. J Neurol, 2015,262(9):2115-2123
[5] 曹丙玉. 盐酸右美托咪啶预防小儿七氟醚全身麻醉苏醒期躁动的临床效果观察[J]. 中华全科医师杂志,2012,11(2):155-156
[6] Yokota H,Yokoyama K,Noguchi H,et al. Post-operative dexmedetomidine-based sedation after uneventful intracranial surgery for unruptured cerebral aneurysm:comparison with propofol-based sedation[J]. Neurocrit Care,2011,14(2):182-187
[7] Ramaswamy AH,Shaikh SI. Comparison of dexmedetomidine-propofol versus fentanyl-propofol for insertion of laryngeal mask airway[J]. J Anaesthesiol Clin Pharmacol,2015,31(2):217-220
[8] Yao Y,Qian B,Lin Y,et al. Intranasal dexmedetomidine premedication reduces minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion and emergence delirium in children: a prospective,randomized,double-blind, placebo-controlled trial[J]. Paediatr Anaesth,2015,25(5):492-498
[9] Savla JR,Ghai B,Bansal D,et al. Effect of intranasal de-xmedetomidine or oral midazolam premedication on sevoflurane EC50 for successful laryngeal mask airway placement in children:a randomized,double-blind,placebo-controlled trial[J]. Paediatr Anaesth,2014,24(4):433-439
[10] Gaszynski T,Gaszynska E,Szewczyk T. Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation[J]. Drug Des Devel Ther,2014,7(8):909-912
[11] 胡晓锋,何丹枫,卢树昌. 右美托咪定对乳腺癌根治手术患者围术期应激反应激素及术后细胞免疫的影响[J]. 实用癌症杂志,2015,30(5):669-672
[12] Bergese SD,Patrick Bender S,McSweeney TD,et al. A comparative study of dexmedetomidine with midazolam and midazolam alone for sedation during elective awake fiberoptic intubation[J]. J Clin Anesth,2010,22(1):35-40
[13] 姜慧芳,周惠丹,连燕虹,等. 右美托咪定对乳腺癌根治术患者Th1/Th2细胞因子的影响[J]. 肿瘤学杂志,2015,21(6)496-498
[14] 丁明霞,张兴梅. 右美托咪定联合氟比洛芬酯用于肺癌根治术患者超前镇痛的效果观察[J/CD]. 中华肺部疾病杂志:电子版,2015,8(5):68-70
[15] 高燕春. 盐酸右美托咪定滴鼻对小儿七氟烷麻醉术前焦虑和术后躁动的影响[D]. 合肥:安徽医科大学,2012
[2] 张瑛,钟文晖,王爱忠,等. 右美托咪定对缺血-再灌注大鼠肠黏膜屏障功能的影响[J]. 上海交通大学学报:医学版,2014,34(4):487-490;506
[3] Ohshima T,Miyachi S,Takahashi I,et al. Assessment of endovascular coil configuration for embolization of intracranial aneurysms using computational fluid dynamics[J]. Nagoya J Med Sci,2015,77(3):383-388
[4] Chen JX,Lai LF,Zheng K,et al. Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment[J]. J Neurol, 2015,262(9):2115-2123
[5] 曹丙玉. 盐酸右美托咪啶预防小儿七氟醚全身麻醉苏醒期躁动的临床效果观察[J]. 中华全科医师杂志,2012,11(2):155-156
[6] Yokota H,Yokoyama K,Noguchi H,et al. Post-operative dexmedetomidine-based sedation after uneventful intracranial surgery for unruptured cerebral aneurysm:comparison with propofol-based sedation[J]. Neurocrit Care,2011,14(2):182-187
[7] Ramaswamy AH,Shaikh SI. Comparison of dexmedetomidine-propofol versus fentanyl-propofol for insertion of laryngeal mask airway[J]. J Anaesthesiol Clin Pharmacol,2015,31(2):217-220
[8] Yao Y,Qian B,Lin Y,et al. Intranasal dexmedetomidine premedication reduces minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion and emergence delirium in children: a prospective,randomized,double-blind, placebo-controlled trial[J]. Paediatr Anaesth,2015,25(5):492-498
[9] Savla JR,Ghai B,Bansal D,et al. Effect of intranasal de-xmedetomidine or oral midazolam premedication on sevoflurane EC50 for successful laryngeal mask airway placement in children:a randomized,double-blind,placebo-controlled trial[J]. Paediatr Anaesth,2014,24(4):433-439
[10] Gaszynski T,Gaszynska E,Szewczyk T. Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation[J]. Drug Des Devel Ther,2014,7(8):909-912
[11] 胡晓锋,何丹枫,卢树昌. 右美托咪定对乳腺癌根治手术患者围术期应激反应激素及术后细胞免疫的影响[J]. 实用癌症杂志,2015,30(5):669-672
[12] Bergese SD,Patrick Bender S,McSweeney TD,et al. A comparative study of dexmedetomidine with midazolam and midazolam alone for sedation during elective awake fiberoptic intubation[J]. J Clin Anesth,2010,22(1):35-40
[13] 姜慧芳,周惠丹,连燕虹,等. 右美托咪定对乳腺癌根治术患者Th1/Th2细胞因子的影响[J]. 肿瘤学杂志,2015,21(6)496-498
[14] 丁明霞,张兴梅. 右美托咪定联合氟比洛芬酯用于肺癌根治术患者超前镇痛的效果观察[J/CD]. 中华肺部疾病杂志:电子版,2015,8(5):68-70
[15] 高燕春. 盐酸右美托咪定滴鼻对小儿七氟烷麻醉术前焦虑和术后躁动的影响[D]. 合肥:安徽医科大学,2012