张自强　朱　波　吴琴丽　陈　蕾浙江中医药大学附属嘉兴中医院麻醉科，浙江嘉兴　314001

不同剂量右美托咪定对小儿全麻苏醒期躁动及苏醒时间的影响

张自强朱波吴琴丽陈蕾
浙江中医药大学附属嘉兴中医院麻醉科，浙江嘉兴314001

目的探讨全麻诱导前给予不同剂量的右美托咪定对小儿全麻后苏醒期躁动及苏醒时间的影响。方法2015年1~6月选择60例ASAⅠ～Ⅱ，4～6岁择期全麻下腺样体切除术的学龄前儿童，采用随机数字表法，将其分为3组（n=20）：右美托咪定0.3 μg/kg组（A组）、右美托咪定0.5 μg/kg组（B组）、对照组（C组）。A、B组分别在全麻诱导前给予0.3 μg/kg和0.5 μg/kg静脉微泵输注右美托咪定（10 min），对照组静脉输注等容量生理盐水。记录观察入室时、麻醉诱导期、术中及恢复期生命体征变化，计算从手术结束到拔管的苏醒时间、全麻术后恢复期苏醒躁动及评分、复苏室停留时间及术后相关并发症等。结果 恢复期与C组相比，A、B组的HR和MAP下降（P<0.01），苏醒时间差异无统计学意义（P＞0.05）；B组较A组术后苏醒躁动发生率及评分较低，差异有统计学意义（P<0.05）；与C组比较，A、B组术后苏醒躁动发生率及评分有统计学差异（P<0.05），复苏室停留时间差异无统计学意义（P>0.05）。结论全麻诱导前给予0.5 μg/kg右美托咪定可以更好地降低全麻后苏醒期躁动的发生率，改善血流动力学，同时不延长苏醒及恢复期的时间。

右美托咪定；苏醒期躁动；全麻；苏醒时间

[Abstract]Objective To investigate the influence of administration of different dose of dexmedetominide before general anesthesia on the emergence agitation and recovering time.Methods From January to June 2015 60 children aging from 4 to 6 years old with ASAⅠ-Ⅱ who were performed adenoidectomy under general anesthesia were selected. Random number table was adopted to divide the 60 patients into 3 groups(n=20):dexmedetominide 0.3 μg/kg group (group A),dexmedetominide 0.5 μg/kg group(group B)and control group(group C).Vein micropump infusion of 0.3 μg/kg and 0.5 μg/kg dexmedetominide was respectively administrated into group A and B before general anesthesia(10 min) and the control group was administrated normal saline of the same volume.Vital signs at the time of entering operative room,anesthetic induction period,during the operation and recovering period were observed and recorded,recovering time from the end of operation to extubation were calculated,agitation and rating of reviving period after general anesthesia,staying time in reviving room and postoperative complications were all observed and recorded.Results HR and MAP in group A and B during reviving period decreased compared with group C(P<0.01)and the reviving time had no significant differences(P＞0.05);group A had lower incidence of emergence agitation and rating compared with group B and the differences had statistical significance(P<0.05);the differences of emergence agitation and rating in group A and B compared with group C had statistical significance(P<0.05),and the staying time in reviving room had no statistical differences(P>0.05).Conclusion Administration of 0.5 μg/kg dexmedetominide before general anesthesia induction can better decrease the incidence of emergence agitation after general anesthesia,improve hemodynamics and not prolong the recovering time and reviving period.

[Key words]Dexmedetomidine;Emergence agitation;General anesthesia;Reviving time

术后躁动是指患者全麻苏醒期意识模糊、认知困难，表现为无理性的哭喊、呻吟，伴有反复的翻身、抓床等行为，严重的躁动则称为谵妄[1]，轻者导致术后出血，颈、胸、腹的引流导管滑脱移位，重者可致滑落损伤或再次手术的风险，常常给临床医疗安全带来巨大挑战。苏醒期躁动的一般发生率为10%～50%，也有报道高至80%，其与麻醉可能的相关因素为快速苏醒、疼痛、年龄、药物和焦虑等有关[2]。……