地佐辛和右美托咪定对小儿耳鼻喉手术后躁动的临床研究.docVIP

地佐辛和右美托咪定对小儿耳鼻喉手术后躁动的临床研究 　　摘要：目的：评价地佐辛和右美托咪定对小儿耳鼻喉手术后苏醒期躁动的影响。方法：选择择期接受全身麻醉下行扁桃体和腺样体切除手术的患儿共90例，ASA分级Ⅰ～Ⅱ级，年龄4-9岁，体重16-28Kg，随机分为右美托咪定组（A组）、地佐辛组（B组）、对照组（C组）三组。用咪唑安定（0.05mg/kg），丙泊酚（2mg/Kg），顺阿曲库胺（0.15mg/kg），芬太尼（2μg/kg）诱导后，术中丙泊酚维持，靶控注射4～6 mg?kg-1?h-1，瑞芬太尼0.1～1.0μg?kg-1?h-1维持麻醉。A组：诱导后给予右美托咪定1μg/kg泵注10min，继之以0.5μg?kg-1?h-1持续泵注至手术结束。B组：在手术结束前10min静脉注射地佐辛0.05mg/Kg。C组：术中泵注等容量的生理盐水。记录手术时间、停药至清醒时间、麻醉后恢复室停留时间;记录躁动发生情况、持续时间，行患儿麻醉苏醒期躁动量化评分（PAED评分）评价患儿的躁动程度;患儿入复苏室即刻（T0）、15 min（T1）、30 min（T2）时行改良东安大略儿童医院疼痛评分（m-CHEOPS评分）和Ramsay评分，分别评价患儿的疼痛程度和镇静程度。结果：与C组相比，A组和B组术后躁动发生率、术后PEAD评分和各时间点m-CHEOPS评分均降低，Ramsay评分升高（Plt;0.05）;与A组相比，B组躁动发生率、PEAD评分和m-CHEOPS评分差异无统计学意义，Ramsay评分降低（Plt;0.05）。结论：右美托咪定和地佐辛均能有效减少全麻下接受扁桃体和腺样体切除手术患儿术后躁动的发生。 　　关键词：右美托咪定; 地佐辛; 小儿;躁动; 　　Abstract：Objective To observe the effect of dexmedetomidine and dezocine on post-operative agitation during general anesthesia induction and maintenance in pediatric adenotonsillectomy patients.Methods Choose elective general anesthesia downlink tonsil and A total of 90 cases of adenoidectomy surgery， ASAⅠ～Ⅱ，aged 4-9 yr，weighing 16-28kg， were randomly divided into A， B， C three groups. Anesthesia was induced with midazolam 0.05mg/kg， Propofol 2mg/Kg， Cisatracurium 0.15mg/kg， fentanyl 2μg/kg， and maintain with propofol 4～6 mg?kg-1?h-1， remifentanil at 0.1～1.0μg?kg-1?h-1. Group A： patients received either1μg/kg over 10 min followed by a maintenance 0.5μg?kg-1?h-1 of dexmedetomidine infusion;Group B：dezocine 0.05mg/kg was injected 10 min before the end of surgery ;Group C： the equal volume of norrnal saline were injected .The extubalion time and length of stay in the post anesthesia care unit（PACU）were recorded.Agitation and the duration were recorded when the children were in PACU.The degree of EA was assessed using the Pediatric Aneslhesia Emergence Delirium（PAED） scale.Pain was evaluated using the modified Children’s Hospital of Eastem 0ntario Pain Scale（m-CHEOPS） and sedation was measured with Ramsay score. Results Compared with g