王伟华 李亚蓉 宋全红

[摘要] 目的 探讨右美托咪定对小儿扁桃体切除术后苏醒期躁动的预防效果及其对血流动力学的影响。 方法 收集2013年8月～2015年4月也门荷台达革命医院择期行扁桃体切除术的患儿50例，随机将其分为右美托咪定组（D组）和对照组（C组），每组25例。麻醉诱导插管后，D组静注右美托咪定0.5 μg/kg，注射时间10 min。C组输注相同容量的0.9%氯化钠注射液，其余麻醉方法相同。观察两组的拔管时间、出室时间、苏醒期Riker镇静躁动评分，比较两组患儿麻醉前（T0）、拔管前（T1）、拔管后（T2）的收缩压（SBP）、舒张压（DBP）、心率（HR），计算各观察时点的二重指数（RPP）。 结果 两组患儿拔管时间、出室时间差异无统计学意义（P>0.05）；D组患儿Riker镇静躁动评分优于C组，差异有统计学意义（P<0.05）；与T0比较，D组T1、T2时SBP、DBP、HR、RPP略有增加，差异无统计学意义（P>0.05）；C组T1、T2时SBP、DBP、HR和RPP升高，差异有统计学意义（P<0.05）；T1、T2时C组SBP、DBP、HR、RPP高于D组，差异有统计学意义（P<0.05）。 结论 右美托咪定对扁桃体切除术后小儿苏醒期躁动有明显的预防效果，患儿血流动力学更稳定。

[关键词] 右美托咪定；小儿；苏醒期躁动；血流动力学反应

[中图分类号] R726.1 [文献标识码] A [文章编号] 1674-4721（2016）02（b）-0098-03

Clinical research of Dexmedetomidine for prevention of emergence agitation and hemodynamic responses in pediatric patients undergoing tonsillectomy

WANG Wei-hua1 LI Ya-rong2 SONG Quan-hong3

1.Department of Anesthesiology，Dalian Second People′s Hospital，Dalian 116011，China；2.Department of Anesthesiology，Dalian Fifth People′s Hospital，Dalian 116021，China；3.Department of Nursing，Dalian Second People′s Hospital，Dalian 116011，China

[Abstract] Objective To investigate the effect of Dexmedetomidine on emergence agitation and hemodynamic responses in pediatric patients. Methods From August 2013 to April 2015，Yemen Hudaydah Revolution Hospital，50 pediatric patients undergoing elective tonsillectomy，were randomly allocated to dexmedetomi dine group （group D，n=25） and control group （group C，n=25）.After anesthetic induction，group D was given the Dexmedetomidine 0.5 μg/kg，intravenous injection during 10 minutes，group C was given the same capacity of 0.9% normal saline intravenous injection during 10 minutes.Parameters records including time of tracheal extubation and out of operating theatre；riker calmrestless score；noninvasive heart rate （HR），systolic blood pressure （SBP） and diastolic blood pressure （DBP） before anesthetic induction （T0） and before （T1） and after tracheal extubation （T2）；rate-pressure product （RPP） were calculated. Results There was no difference in time of tracheal extubation and out of operating theatre （P>0.05）；riker calmrestless score in group D was significantly better than group C，there was significant difference （P<0.05）；the SBP，DBP，HR and RPP compared preinduction （T0） with before（T1） and after （T2） tracheal extubation in group D， there were no significant differences （P>0.05）；the SBP，DBP，HR and RPP compared preinduction （T0） with before （T1） and after （T2） tracheal extubation in group C，there were significant differences （P<0.05）.In group D，SBP，DBP，HR and RPP at T1 and T2 were significant lower than those in group C with significant differences （P<0.05）. Conclusion Dexmedetomidine can reduce the occurrence of emrgence agitation and hemodynamic responses in pediatric patients undergoing tonsillectomy.

[Key words] Dexmedetomidine；Pediatric patients；Emergence agitation；Hemodynamic response

小儿扁桃体切除术后出现躁动的概率很高，术后躁动会增加伤口裂开、创面出血甚至患儿意外拔管窒息的危险性，加大了麻醉风险，降低了患儿及家属对麻醉的满意度。右美托咪定是一种高度选择性α2肾上腺受体激动剂，具有镇静镇痛、抑制交感神经活性、抗寒战等特点，并且能够防止成人全麻术后苏醒期躁动的发生[1]。作为镇静镇痛药，右美托咪定不同于其他的镇静剂，能够保证呼吸稳定而不引起通气障碍[2]，当连续输注时，它与可预测和稳定的血流动力学反应相关联[3]。因其在治疗剂量内无呼吸抑制的优点，现已广泛应用于小儿麻醉[4]。本研……