作者单位：518026深圳市广东省深圳市儿童医院麻醉科

王敬华：女，本科，主管护师

右美托咪啶和丙泊酚对儿童七氟烷麻醉苏醒期躁动的影响

王敬华蒋坤王子龙

摘要目的：探讨右美托咪啶和丙泊酚对抑制患儿七氟烷吸入麻醉苏醒期躁动的临床治疗效果。方法：选取2013年1月~2014年1月我院行腹腔镜疝囊高位结扎术和隐睾下降固定术患儿60例作为研究对象，将其随机等分为A，B，C三组，三组患儿均采用面罩8%七氟烷吸入麻醉诱导，手术结束后立即送入麻醉复苏室，A组给予0.9%氯化钠2 ml注射液，B组经茂菲式滴管滴注0.7 μg/kg右美托咪啶注射液，C组给予丙泊酚0.1 mg/kg静脉注射，比较三组患儿的苏醒时间、苏醒后的疼痛评分、躁动以及不良反应发生率。结果：三组患儿苏醒时间以及并发症发生率差异无统计学意义(P<0.05)，疼痛以及躁动评分比较差异有统计学意义(P<0.05)。结论：右美托咪啶和丙泊酚可以明显降低七氟烷吸入麻醉患儿苏醒发生躁动的概率，且镇痛效果较好，不会延长患儿苏醒时间，且无明显不良症状，安全有效，值得在临床推广应用。

关键词右美托咪啶；丙泊酚；麻醉；苏醒；躁动；效果doi:10.3969/j.issn.1672-9676.2015.02.005

收稿日期：(2014-05-07)

Influence of dexmedetomidine hydrochloride injection and propofol on restlessness in wake up stage with sevoflurane anesthesia

WANG Jing-hua,JIANG Kun,WANG Zi-long(Shenzhen Children′s Hospital,Shenzhen518026)

AbstractObjective:To study the dexmedetomidine hydrochloride injection and propofol to curb child sevoflurane inhalation anesthesia awakening period clinical treatment effect of agitation.Randomly selected from January 2013 to January 2014 in our hospital between rows of laparoscopic hernia sac high ligation and decline in cryptorchidism fixation with 60 cases as the research objectes,which was divided into normal saline(group A),dexmedetomidine hydrochloride injection(group B) and propofol group(C) three groups,each group of children with 20 cases.Three groups of children all used mask 8% sevoflurane inhalation anesthesia induction,immediately after the surgery to the anesthesia recovery room,gave 2 ml of 0.9% sodium chloride injection in group A,group B was gave 0.7 μg/kg dexmedetomidine hydrochloride injection,group C give propofol 0.1 mg/kg propofol injection.To compare three groups of children with time,pain and agitation and complications after waking up. Results:The waking time and incidence of complications has no obvious difference among three groups.The pain and agitated after waking score among three groups,the statistical result has obvious difference(P<0.05).Conclusion:Dexmedetomidine hydrochloride injection and propofol sevoflurane inhalation anesthesia can cut down obviously with the probability of restlessness woke up in,and the analgesic effect is good,will not extend the children wake up time and no obvious adverse symptoms occur,safe and effective,can be suitable for clinical promotion.

Key wordsDexmedetomidine hydrochloride injection;Propofol;Anesthesia;Wake up;Restlessness;Effect

七氟烷麻醉为含氟的吸入麻醉药，其最小肺泡内浓度(MAC)，在氧及氧化亚氮的混合气体中为0.66%；在纯氧中为1.7%；与恩氟烷者相似，为恩氟烷者的1/2。其半数致死浓度(LC50)/MAC比恩氟烷大[1-3]。诱导时间比恩氟烷、氟烷者为短，苏醒时间三者无大差异，以50%~70%氧化亚氮与七氟烷2.5%~4%吸入，使用睡眠量的静脉麻醉时，诱导量通常为0.5%~5%，麻醉维持应以最低有效浓度维持外科麻醉状态，常为4%以下[4-6]。当儿童进行七氟烷麻醉时，极易引发患儿苏醒后躁动，苏醒期躁动是患儿在全身麻醉苏醒后表现出的神经精神系统的功能紊乱，通常临床表现为兴奋、躁……