关圆 庞晓林 张东亚

[摘要] 目的 探討右旋美托咪啶对室上性心动过速（以下简称“室上速”）患儿七氟烷麻醉血流动力学及苏醒期躁动的影响。 方法 选取2013年1月～2017年8月在清华大学第一附属医院北京华信医院行射频消融术的室上速患儿63例，按照随机数字表法将患儿分为A、B、C三组，每组各21例。术前A组静脉注射右旋美托咪啶0.3 μg/kg，B组静脉注射右旋美托咪啶0.5 μg/kg，C组（对照组）静注生理盐水。观察比较手术开始后静脉注射生理盐水及右旋美托咪啶组注射前（T0）、注射后5 min（T1）、注射后10 min（T2）、患儿清醒时（T3）、拔喉罩后5 min（T4）、拔喉罩后10 min（T5）的有创平均动脉压（MAP）、心率（HR）；记录三组患儿手术时间、苏醒时间、拔管时间并采用小儿麻醉后苏醒躁动（PAED）评分量表和Watcha评分评估三组患儿苏醒后躁动情况，记录躁动持续时间> 15 min的发生率；记录术后不良反应发生情况。 结果 与T0比较，A组和C组T3～T5时MAP、HR值均明显升高，差异有统计学意义（P < 0.05）；B组各时间点MAP、HR值比较，差异无统计学意义（P > 0.05）；与C组比较，A组和B组T3～T5时MAP、HR值显著降低，且B组T3～T5时MAP、HR值低于A组，差异均有统计学意义（P < 0.05）。与C组比较，A组、B组PEAD评分、Watcha评分、躁动持续时间> 15 min的发生率均明显降低，且B组显著低于A组，差异均有统计学意义（P < 0.05）。治疗后，A组及B组总不良反应发生率（23.80%、9.52%）均低于C组（57.14%），且B组低于A组，差异均有统计学意义（P < 0.05）。 结论 右旋美托咪啶可以有效缓解室上速小儿七氟烷全麻苏醒期躁动发生，改善血流动力学变化，降低不良反应的发生，值得临床推广。

[关键词] 右旋美托咪啶；七氟烷；血流动力学；苏醒期躁动

[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0096-04

[Abstract] Objective To investigate the effects of Dexmedetomidine on hemodynamics and restlessness during Sevoflurane anesthesia in children with supraventricular tachycardia. Methods A total of 63 cases of supraventricular tachycardia children who were treated with radiofrequency ablation in Beijing Huaxin Hospital， the First Affiliated Hospital of Tsinghua University from January 2013 to August 2017 were selected and divided into group A， B and C according to the random number table method， with 21 cases in each group. Before operation， children in group A were intravenously injected Dexmedetomidine 0.3 μg/kg， children in group B were injected Dexmedetomidine intravenously 0.5 μg/kg， and children in group C （control group） were injected with normal saline. The mean arterial pressure （MAP） and heart rate（HR） of T0， T1， T2， T3， T4 and T5 were observed and compared. The operation time， waking time， extubation time after treatment in 3 groups were recorded. The PAED scale and Watcha score were used to assess restlessness after awakening in these children. The incidence of > 15 min in the restless duration was recorded. Adverse reactions after the operation were recorded. Results Compared with T0， the MAP and HR from T3 to T5 in the group A and C increased with statistically significant differences （P < 0.05）， and the differences on the MAP and HR in the group B at each time point was no statistically significant （P < 0.05）. Compared with the group C， the MAP and HR from T3 to T5 in group A and B was decreased significantly （P < 0.05）， and the MAP and HR in the group B was significantly lower than those of the group A. The scores of PEAD， Watcha and restless duration > 15 min in group A and B was lower than that in group C， and the scores group B was lower than that in group A， the differences of were statistically significant （P < 0.05）. After treatment， the incidence of total adverse reactions in group A （23.80%） and group B （9.52%） were lower than that in group C （57.14%）， and adverse reactions in group B were significantly lower than that in group A （P < 0.05）. Conclusion Dexmedetomidine can effectively alleviate the restlessness in the awakening period of Sevoflurane in children with supraventricular tachycardia， improve hemodynamic changes， reduce the adverse reactions.

[Key words] Dexmedetomidine； Sevoflurane； Hemodynamics； Restlessness during recovery period

全麻苏醒期躁动（emergence agitation，EA）是全麻术后苏醒期出现的一种较常见的并发症[1]。七氟烷（别名“七氟醚”）为一种含氟的新型吸入麻醉药，具有血液动力学较平稳、用药量小、术后苏醒快等优点，被广泛用于小儿麻醉[2]。随着七氟烷在临床中广泛应用，也被发现其容易引起患儿术后躁動，有研究表明，使用七氟烷维持麻醉，患儿术后躁动发生率达到18%～80%[2-3]。麻……