术前单次静脉注射右美托咪定在小儿静脉全麻隐睾固定术中的应用
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摘要
目的观察术前单次静脉注射右美托咪定在小儿静脉全麻隐睾固定术中的应用。方法选择该院2016年1月——2017年12月行隐睾固定术患儿40例,年龄5～7岁,体重18～26 kg,随机将患者分为观察组和对照组,各20例。观察组患儿在术前60 min静脉单次输注右美托咪定0.5μg/kg,输注时间为10 min;对照组患儿在术前60 min给予等容量0.9%氯化钠溶液。给药30 min后对二组患儿与父母分离表现进行父母分离焦虑量表(PSAS)评分;入室时对患儿进行镇静情绪评分(Ramsay)。麻醉诱导时,二组患儿静脉注射丙泊酚2 mg/kg、芬太尼4μg/kg,所有患儿均在睫毛反射消失后给予顺本阿曲库铵0.1 mg/kg后4～6 min完成气管插管,然后麻醉机机械控制通气,潮气量控制在8～10 ml/kg,呼吸频率控制在16～20次/min,吸入氧流量2 L/min,吸呼比1∶2,调整呼吸参数维持PETCO2于30～35 mmHg。麻醉维持采用静脉微量泵泵注瑞芬太尼0.2μg/(kg·min)和丙泊酚5 mg/(kg·h)。在手术结束时停止泵入瑞芬太尼和丙泊酚,手术结束后患儿由麻醉医生送至麻醉恢复室(PACU),苏醒期进行儿科麻醉谵妄量表(PAEDS)评分。结果患儿PSAS评分情况,二组间差异无统计学意义(P>0.05);二组患儿麻醉期间,未出现低血压、心动过缓;二组患儿麻醉苏醒期,出现恶心、呕吐不良并发症共6例,其中观察组1例,对照组5例;40例患儿中8例出现麻醉苏醒期谵妄(占20%),其中观察组1例,对照组7例,二组间比较差异有统计学意义(P<0.05);观察组苏醒时间和术中瑞芬太尼、丙泊酚的用量均少于对照组。结论入手术室前60 min,对患儿进行单次静脉缓慢注射右美托咪定0.5μg/kg,注射时间10 min,对减轻小儿术前焦虑无明显作用,但可以有效降低苏醒期谵妄发生机会及严重程度,明显降低术后恶心、呕吐等不良反应。
Objective To observe the application of dexmedetomidine once before intravenous anesthesia in children with intravenous anesthesia for cryptorchidism.Methods From January 2016 to December 2017,forty children with cryptorchidism underwent cryptorchidism,aged 5-7 years and weighing 18-26 kg,were randomly divided into observation group and control group,20 cases in each group.The observation group received dexmedetomidine 0.5μg/kg intravenously for 10 min at 60 min before operation,while the control group received 0.9% sodium chloride solution of equal volume at 60 min before operation.30 min after medication,parents’ separation anxiety scale(PSAS) was used to evaluate the separation performance between the two groups,and the sedative mood score(Ramsay) was used to evaluate the separation performance between the two groups.During anesthesia induction,propofol 2 mg/kg and fentanyl 4μg/kg were intravenously injected into the two groups.All the children were given cisplatin 0.1 mg/kg 4-6 minutes after the disappearance of eyelash reflex to complete tracheal intubation,then mechanical ventilation was controlled by anesthesia machine,tidal volume was controlled at 8-10 ml/kg,respiratory frequency was controlled at 16-20 times/min,oxygen flow rate was 2 L/min,inspiration-expiration ratio was 1︰2,and respiratory parameters were adjusted.The holding capacity of PETCO_2 ranges from 30 to 35 mmHg.Remifentanil 0.2μg/(kg·min) and propofol 5mg/(kg·h) were infused by intravenous micropump to maintain anesthesia.Remifentanil and propofol were stopped at the end of the operation.After the operation,the children were sent to the anesthesia recovery room(PACU) by the anesthesiologist.The paediatric delirium scale(PAEDS) was scored during the recovery period.Results There was no significant difference in PSAS score between the two groups(P>0.05);no hypotension or bradycardia occurred during anesthesia in the two groups;6 cases of nausea and vomiting complications occurred during anesthesia recovery period in the two groups,including 1 case in the observation group and 5 cases in the control group;8 cases(20%) of 40 children had delirium during anesthesia recovery period,including 1 case in the observation group and 7 cases in the control group.There was significant difference between the two groups(P<0.05);the recovery time and intraoperative dosage of remifentanil and propofol in the observation group were less than those in the control group.Conclusion 60 min before entering the operating room,a single intravenous slow injection of dexmedetomidine 0.5μg/kg for 10 min had no significant effect on alleviating preoperative anxiety in children,but it could effectively reduce the occurrence and severity of delirium in recovery period,and significantly reduce the adverse reactions such as nausea and vomiting after operation.
Objective To observe the application of dexmedetomidine once before intravenous anesthesia in children with intravenous anesthesia for cryptorchidism.Methods From January 2016 to December 2017,forty children with cryptorchidism underwent cryptorchidism,aged 5-7 years and weighing 18-26 kg,were randomly divided into observation group and control group,20 cases in each group.The observation group received dexmedetomidine 0.5μg/kg intravenously for 10 min at 60 min before operation,while the control group received 0.9% sodium chloride solution of equal volume at 60 min before operation.30 min after medication,parents’ separation anxiety scale(PSAS) was used to evaluate the separation performance between the two groups,and the sedative mood score(Ramsay) was used to evaluate the separation performance between the two groups.During anesthesia induction,propofol 2 mg/kg and fentanyl 4μg/kg were intravenously injected into the two groups.All the children were given cisplatin 0.1 mg/kg 4-6 minutes after the disappearance of eyelash reflex to complete tracheal intubation,then mechanical ventilation was controlled by anesthesia machine,tidal volume was controlled at 8-10 ml/kg,respiratory frequency was controlled at 16-20 times/min,oxygen flow rate was 2 L/min,inspiration-expiration ratio was 1︰2,and respiratory parameters were adjusted.The holding capacity of PETCO_2 ranges from 30 to 35 mmHg.Remifentanil 0.2μg/(kg·min) and propofol 5mg/(kg·h) were infused by intravenous micropump to maintain anesthesia.Remifentanil and propofol were stopped at the end of the operation.After the operation,the children were sent to the anesthesia recovery room(PACU) by the anesthesiologist.The paediatric delirium scale(PAEDS) was scored during the recovery period.Results There was no significant difference in PSAS score between the two groups(P>0.05);no hypotension or bradycardia occurred during anesthesia in the two groups;6 cases of nausea and vomiting complications occurred during anesthesia recovery period in the two groups,including 1 case in the observation group and 5 cases in the control group;8 cases(20%) of 40 children had delirium during anesthesia recovery period,including 1 case in the observation group and 7 cases in the control group.There was significant difference between the two groups(P<0.05);the recovery time and intraoperative dosage of remifentanil and propofol in the observation group were less than those in the control group.Conclusion 60 min before entering the operating room,a single intravenous slow injection of dexmedetomidine 0.5μg/kg for 10 min had no significant effect on alleviating preoperative anxiety in children,but it could effectively reduce the occurrence and severity of delirium in recovery period,and significantly reduce the adverse reactions such as nausea and vomiting after operation.
引文
[1]Poorolajal J,Ashtarani F,Alimohammadi N.Effect of Benson relaxation technique on the preoperative anxiety and hemodynamic status:A single blind randomized clinical trial[J].Artery Research,2017,17:33-38
[2]Elbakry A E,Ibrahim E.Propofol-dexmedetomidine versus propofol-remifentanil conscious sedation for awake craniotomy during epilepsy surgery[J].Minerva Anestesiologica,2017,83(12):1248-1254
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[4]钱鹏,邹振宇,宋仕钦,等.右美托咪定与芬太尼复合罗哌卡因硬膜外麻醉的对比研究[J].中国煤炭工业医学杂志,2015,18(8):1341-1345
[5]Zub D,Berkenbosch JW,Tobias JD.Preliminary experience with oral dexmedetomidine for procedural and anesthetic premedication[J].Paediatr Anaesth,2005,15(11):932-938
[6]Sheta SA,Al-Sarheed MA,Abdelhalim AA.Int-ranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation:A double blinded randomized controlled trial[J].Paediatr Anaesth,2014,24(2):181-189
[7]牛俊瑞,段霞光,郝春光.右美托咪定对脑缺血再灌注损伤后大脑皮质的保护作用[J].中国煤炭工业医学杂志,2017,20(1):60-63
[8]Malone B,Firstenberg M S.The importance of identifying patients at risk of dexmedetomidine-associated hypotension.[J].International Journal of Critical Illness&Injury Science,2016,6(4):165-166
[9]Zhang H,Fang B,Zhou W.The efficacy of dexmedetomidine-remifentanil versus dexmedetomidinepropofol in children undergoing flexible bronchoscopy:A retrospective trial[J].Medicine,2017,96(1):5815
[10]Su F,Hammer GB.Dexmedetomidine:pediatric pharmacology,clinical uses and safety[J].Expert Opin Drug Saf,2011,10(1):55-66
[11]傅志玲.丙泊酚静脉麻醉下行斜视手术结束前给予右美托咪定对患儿术后躁动的影响[J].中国医药,2018,13(5):770-772
[12]倪如飞,刘吉平,黄海文,等.右美托咪定预防儿童全麻苏醒期躁动和谵妄的安全有效剂量[J].广东医学,2017,38(11):1750-1753
[13]Bonanno LS,Pierce S,Badeaux J,et al.Effectiveness of preoperative intranasal dexmedetomidine compared with oral midazolam for the prevention of emergence delirium in pediatric patients undergoing genera l anesthesia:A systematic review protocol[J].JBI Database System Rev Implement Rep,2016,14(8):70-79
[14]Rosen HD,Mervitz D,Cravero JP.Pediatric emergence delirium:Canadian pediatric anesthesiologists′experience[J].Paediatr Anaesth,2016,26(2):207-212
[15]Brahmbhatt K,Whitgob E.Diagnosis and Management of Delirium in Critically Ill Infants:Case Report and Review[J].Pediatrics,2016,137(3):20151940
[16]Lerman J.Dose the risk scale predict emergence agitation in children[J].Anesth Analg,2018,126(1):365
[17]Saadawy I,Boker A,Elshahawy MA,et al.Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics[J].Acta Anaesthesiol Scand,2009,53(2):251-256
[18]马孝武,张宜林,武军,等.右美托咪定对小儿全麻苏醒期的影响[J].中国现代医学杂志,2012,22(3):82-84
[2]Elbakry A E,Ibrahim E.Propofol-dexmedetomidine versus propofol-remifentanil conscious sedation for awake craniotomy during epilepsy surgery[J].Minerva Anestesiologica,2017,83(12):1248-1254
[3]肖玲燕,史东阳,卢虎,等.右美托咪定治疗重型破伤风抽搐的疗效分析[J].临床麻醉学杂志,2017(11):1115-1116
[4]钱鹏,邹振宇,宋仕钦,等.右美托咪定与芬太尼复合罗哌卡因硬膜外麻醉的对比研究[J].中国煤炭工业医学杂志,2015,18(8):1341-1345
[5]Zub D,Berkenbosch JW,Tobias JD.Preliminary experience with oral dexmedetomidine for procedural and anesthetic premedication[J].Paediatr Anaesth,2005,15(11):932-938
[6]Sheta SA,Al-Sarheed MA,Abdelhalim AA.Int-ranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation:A double blinded randomized controlled trial[J].Paediatr Anaesth,2014,24(2):181-189
[7]牛俊瑞,段霞光,郝春光.右美托咪定对脑缺血再灌注损伤后大脑皮质的保护作用[J].中国煤炭工业医学杂志,2017,20(1):60-63
[8]Malone B,Firstenberg M S.The importance of identifying patients at risk of dexmedetomidine-associated hypotension.[J].International Journal of Critical Illness&Injury Science,2016,6(4):165-166
[9]Zhang H,Fang B,Zhou W.The efficacy of dexmedetomidine-remifentanil versus dexmedetomidinepropofol in children undergoing flexible bronchoscopy:A retrospective trial[J].Medicine,2017,96(1):5815
[10]Su F,Hammer GB.Dexmedetomidine:pediatric pharmacology,clinical uses and safety[J].Expert Opin Drug Saf,2011,10(1):55-66
[11]傅志玲.丙泊酚静脉麻醉下行斜视手术结束前给予右美托咪定对患儿术后躁动的影响[J].中国医药,2018,13(5):770-772
[12]倪如飞,刘吉平,黄海文,等.右美托咪定预防儿童全麻苏醒期躁动和谵妄的安全有效剂量[J].广东医学,2017,38(11):1750-1753
[13]Bonanno LS,Pierce S,Badeaux J,et al.Effectiveness of preoperative intranasal dexmedetomidine compared with oral midazolam for the prevention of emergence delirium in pediatric patients undergoing genera l anesthesia:A systematic review protocol[J].JBI Database System Rev Implement Rep,2016,14(8):70-79
[14]Rosen HD,Mervitz D,Cravero JP.Pediatric emergence delirium:Canadian pediatric anesthesiologists′experience[J].Paediatr Anaesth,2016,26(2):207-212
[15]Brahmbhatt K,Whitgob E.Diagnosis and Management of Delirium in Critically Ill Infants:Case Report and Review[J].Pediatrics,2016,137(3):20151940
[16]Lerman J.Dose the risk scale predict emergence agitation in children[J].Anesth Analg,2018,126(1):365
[17]Saadawy I,Boker A,Elshahawy MA,et al.Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics[J].Acta Anaesthesiol Scand,2009,53(2):251-256
[18]马孝武,张宜林,武军,等.右美托咪定对小儿全麻苏醒期的影响[J].中国现代医学杂志,2012,22(3):82-84