口腔医学研究

口腔医学研究 ›› 2020, Vol. 36 ›› Issue (2): 181-184.DOI: 10.13701/j.cnki.kqyxyj.2020.02.021

• 口腔麻醉学研究 • 上一篇    下一篇

右美托咪定对全麻龋齿治疗患儿应激反应及苏醒质量的影响

刘光, 刘支娜*, 张玲, 金宏全, 王晓丹, 乔伟娜, 桑弘扬   

  1. 保定市儿童医院/北京儿童医院保定医院麻醉科保定市儿童呼吸消化疾病临床研究重点实验室 河北 保定 071000
  • 收稿日期:2019-06-11 出版日期:2020-02-28 发布日期:2020-04-24
  • 通讯作者: 刘支娜,E-mail:wenwen9604@163.com
  • 作者简介:刘光(1983~ ),男,河北定州人,主治医师,硕士研究生,研究方向为儿童口腔麻醉与围术期医学。

Effects of Dexmedetomidine on Stress Reaction and Awakening Quality in Children with Dental Caries under General Anesthesia

LIU Guang, LIU Zhina*, ZHANG Ling, JIN Hongquan, WANG Xiaodan, QIAO Weina, SANG Hongyang   

  1. Baoding Children's Hospital/Baoding Branch of Beijing Children's Hospital, Baoding Children's Respiratory and Digestive Diseases Clinical Research Key Laboratory, Baoding 071000, China
  • Received:2019-06-11 Online:2020-02-28 Published:2020-04-24

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摘要： 目的:探讨右美托咪定对全麻龋齿治疗患儿围术期应激反应及苏醒质量的影响。方法:择期全麻下行复杂龋齿治疗术患儿64例,年龄3～6岁,ASA Ⅰ级。随机将患儿分为右美托咪定组(D组)和对照组(C组),每组32例。D组在麻醉诱导同时泵注0.5 μg/kg右美托咪定15 min,然后以0.4 μg·kg-1·h-1持续泵注至术毕前30 min。C组以同样方案泵注生理盐水。分别记录麻醉前(T0)、手术开始后1h(T1)、术毕(T2)、苏醒时(T3)的HR、MBP,以及血浆皮质醇(Cor)、去甲肾上腺素(NE)、血糖(Glu)水平,记录手术时间、术中丙泊酚总用量、自主呼吸恢复时间、拔管时间、苏醒时Ramsay镇静评分、FLACC镇痛评分与PAED躁动评分。结果:(1)围术期生命体征比较,T0时,患儿HR、MAP组间差异无统计学意义(P＞0.05),T1、T2、T3时,D组HR、MAP显著低于C组(P＜0.05)。(2)应激反应指标比较:T0时,两组患儿Cor、NE、Glu水平差异无统计学意义(P＞0.05),T1、T2、T3时,D组Cor、NE、Glu显著低于C组(P＜0.05)。(3)复苏质量与麻醉药总量比较:两组患儿自主呼吸恢复时间与拔管时间差异无统计学意义(P＞0.05)。与C 组相比,D组患儿丙泊酚总用量、镇静、镇痛、躁动评分值显著低于C组(P＜0.05)。结论:右美托咪定持续输注用于全麻龋齿治疗患儿,围术期血流动力学更稳定,降低应激反应,提高苏醒质量。

关键词: 右美托咪定, 儿童, 应激, 苏醒质量

Abstract: Objective: To explore the effects of dexmedetomidine on the stress reaction and awakening quality in children with dental caries under general anesthesia. Methods: 64 pediatric patients undergoing elective dental treatment under general anesthesia (aged 3~6 years, ASA grade Ⅰ) were randomly divided into two groups (n=32) using a random number table: dexmedetomidine group (group D) and control group (group C). Group D received 0.5 μg/kg dexmedetomidine at the beginning of anesthesia induction for 15 minutes, and then continued to pump at the rate of 0.4 μg·kg-1·h-1 until 30 minutes before the end of operation. In group C, normal saline was pumped in the same way. HR, MBP, Cor, NE, and Glu were recorded before anesthesia, 1 hour after the operation, at the end of operation, and at the time of awakening. Time of operation, total dosage of propofol, time of spontaneous breathing recovery, time of extubation, Ramsay score, FLACC score, and PAED score were recorded. Results: There was no significant difference in HR and MAP between groups at T0 (P＞0.05). HR and MAP in group D were significantly lower than those in group C at T1, T2 and T3 (P < 0.05). There was no significant difference in Cor, NE, and Glu between two groups at T0 (P＞0.05). Cor, NE, and Glu in group D were significantly lower than those in group C at T1, T2, and T3 (P < 0.05). There was no significant difference in recovery time of spontaneous breathing and extubation time between two groups (P＞0.05). Compared with group C, the total dosage of propofol, Ramsay score, FLACC score, and PAED score in group D were significantly lower than those in group C (P<0.05). Conclusion: Continuous infusion of dexmedetomidine during general anesthesia for children with dental caries can stabilize perioperative hemodynamics, reduce stress reaction, and improve awakening quality.

Key words: dexmedetomidine, child, stress, awakening quality