右美托咪定和咪达唑仑对小儿静脉吸入复合麻醉苏醒期躁动的影响

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　　 【摘要】 目的：觀察右美托咪定和咪达唑仑对小儿静脉吸入复合麻醉苏醒期躁动的影响。方法：选取2018年1月-2019年1月笔者所在医院收治的拟择期行静脉吸入复合麻醉手术患儿90例，均予七氟烷诱导并维持。按随机数字表法分成A组（45例）与B组（45例），A组采取右美托咪定预防麻醉苏醒期躁动，B组采取咪达唑仑预防麻醉苏醒期躁动。对照两组用药前后血流动力学指标、麻醉苏醒时间、持续镇痛时间、苏醒期躁动评分、苏醒期并发症发生率。结果：两组MAP、HR、SpO2、VRS、RSS、麻醉苏醒时间、持续镇痛时间对比，差异均无统计学意义（P>0.05）。两组用药后MAP、HR、SpO2、VRS均低于用药前，RSS均高于用药前，差异均有统计学意义（P<0.05）。A组RS评分低于B组，差异有统计学意义（P<0.05）。A组麻醉苏醒期并发症发生率为0，明显低于对照组的11.11%，差异有统计学意义（P<0.05）。结论：在小儿静脉吸入复合麻醉手术前采用适量右美托咪定，可在不改变血流动力学、麻醉苏醒时间、持续镇痛时间情况下，明显减少苏醒期躁动，降低并发症发生率。
　　 【关键词】 右美托咪定 咪达唑仑 小儿手术 静脉吸入复合麻醉 苏醒期躁动
　　 [Abstract] Objective： To observe the effects of Dexmedetomidine and Midazolam on restlessness during recovery period of intravenous inhalation anesthesia in children. Method： A total of 90 children scheduled for intravenous inhalation anesthesia in our hospital from January 2018 to January 2019 were treated with Sevoflurane induction and maintenance. According to the random number table method， children were divided into the group A （45 cases） and the group B （45 cases）. The group A was treated with Dexmedetomidine to prevent restlessness during recovery period. And the group B was treated with Midazolam to prevent restlessness during recovery period. The hemodynamic parameters before and after treatment， anesthesia recovery time， duration of continuous analgesia， restlessness scores and complications rate during recovery period were compared between the two groups. Result： MAP， HR， SpO2， VRS， RSS， anesthesia recovery time， duration of continuous analgesia were compared between the two groups， and the differences were not statistically significant （P>0.05）. After treatment， MAP， HR， SpO2， VRS of the two groups were lower than those before treatment， and RSS of the two groups were higher than those before treatment， and the differences were statistically significant （P<0.05）. The RS score of the group A was lower than that of the group B， and the difference was statistically significant （P<0.05）. The complication rate during recovery period of the group A was 0， which was significantly lower than 11.11% of the group B， and the difference was statistically significant （P<0.05）. Conclusion： Dexmedetomidine was given to children before intravenous inhalation anesthesia， which can significantly reduce restlessness during recovery period and complication rate without changing hemodynamics， anesthesia recovery time and duration of continuous analgesia.
　　 [Key words] Dexmedetomidine Midazolam Pediatric surgery Intravenous inhalation anesthesia Restlessness during recovery period 　　参考文献
　　[1]徐斐，敖虎山.盐酸右美托咪定的临床应用[J].中国循环杂志，2015，30（4）：401-403.
　　[2]王鹏，单世民.右美托咪定在小儿外科麻醉和镇痛中的应用进展[J].医学理论与实践，2016，29（12）：1563-1564.
　　[3]杨勇，周静，拾翠翠，等.右美托咪定和咪达唑仑对小儿静脉吸入复合麻醉苏醒期躁动的影响研究[J].临床小儿外科杂志，2018，17（7）：547-551.
　　[4]吴新民，薛张纲，马虹，等.右美托咪啶临床应用专家共识（2018）[J].临床麻醉学杂志，2018，34（8）：94-97.
　　[5] Bong C L，Lim E，Allen J C，et al.A comparison of single-dose Dexmedetomidine or Propofol on the incidence of emergence delirium in children undergoing general anaes-thesia for magnetic resonance imaging[J].Anaesthesia，2015，70（4）：393-399.
　　[6] Chou R，Gordon D B，De Leon-Casasola O A，et al.Management of postoperative pain：a clinical practice guideline from the American Pain Society，the American Society of Regional Anesthesia and Pain Medicine，and the American Society of Anesthe-siolo-gists Committee on Regional Anesthesia，Executive Committee，and Administrative Council[J].The Journal of Pain，2016，17（2）：131-157.
　　[7]楊峻岭，郝再军.右美托咪定对小儿术后躁动的影响观察[J].中国医药指南，2014，12（12）：150-151.
　　[8] Iwasai S，Kinoshita Y，Asagoe Y，et al.Anaphylactoid reactions suspected to be caused by Neostigmine in pediatric patients under general anesthesia[J].Masui，2016，65（4）：377-379.
　　[9] Fujisawa T，Komasawa N，Fujiwara A，et al.Effective Dexmedetomidine administration for the prevention of emergence agitation and postoperative delirium in patients with a history of postoperative delirium[J].Masui，2016，65（4）：395-397.
　　[10]张玲，尹正春，叶祝英，等.丙泊酚联合七氟醚麻醉对小儿腹腔镜疝囊高位结扎术血流动力学及麻醉趋势指数的影响[J].中国当代医药，2019，26（17）：133-136.
　　[11] Verma V，Beethe A B，Leriger M，et al.Anesthesia complications of pediatric radiation therapy[J].Pract Radiat Oncol，2016，6（3）：143-154.
　　[12]王晶华.盐酸右美托咪定在小儿麻醉的临床应用进展[J].世界最新医学信息文摘，2019，19（43）：79-80.
　　（收稿日期：2019-11-07） （本文编辑：李盈）
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