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成都市妇女儿童中心医院麻醉科
纸质出版日期:2017,
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徐晓燕, 张成, 黄振华. 右美托咪定在幼儿气管镜检异物取出术麻醉中的应用[J]. 重庆医科大学学报, 2017,42(5):579-582.
Xu Xiaoyan, Zhang Cheng, Huang Zhenhua. Application of dexmedetomidine in anesthesia for bronchial foreign body removal in pediatric patients[J]. Journal of Chongqing Medical University, 2017,42(5):579-582.
徐晓燕, 张成, 黄振华. 右美托咪定在幼儿气管镜检异物取出术麻醉中的应用[J]. 重庆医科大学学报, 2017,42(5):579-582. DOI: 10.13406/j.cnki.cyxb.001190.
Xu Xiaoyan, Zhang Cheng, Huang Zhenhua. Application of dexmedetomidine in anesthesia for bronchial foreign body removal in pediatric patients[J]. Journal of Chongqing Medical University, 2017,42(5):579-582. DOI: 10.13406/j.cnki.cyxb.001190.
目的:探索右美托咪定在幼儿气管镜检异物取出术中的应用
观察右美托咪定对围术期患儿呼吸及循环功能的影响。方法:纳入2013年7月至2015年11月期间因气道异物拟行保留自主呼吸全身麻醉气管镜检异物取出术患儿80例
随机分为2组(n=40):右美托咪定组(D组)、对照组(C组)。所有患儿诱导均采用七氟烷
而后D组患儿采用右美托咪定复合瑞芬太尼靶控输注维持麻醉;C组患儿采用丙泊酚复合瑞芬太尼靶控输注维持麻醉
异物取出并撤出气管镜即停止药物输注。观察2组患儿麻醉诱导前(T0)、喉镜表面麻醉时(T1)、气管镜置入时(T2)、气管镜置入后5 min(T3)、气管镜撤出时(T4)、气管镜撤出后5min(T5)、患儿出PACU时(T6)的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)改变;观察2组患儿术中及术后屏气、呛咳、喉痉挛、呼吸抑制、低氧血症等发生率;记录患儿麻醉时间、手术时间及苏醒时间。结果:与T0相比
D组患儿术中时间点(T1
T
4)HR、MAP及RR下降幅度低于C组
术中T1
T
4时间点三者水平C组低于D组(P
<
0.01);D组及C组患儿手术时间及麻醉时间组间差异无统计学意义[(22.35±4.50)min vs.(22.43±4.70)min]
而D组苏醒时间长于C组
差异有统计学意义(21[16
25]
min vs.13[11
15]min
P
<
0.01);D组呼吸抑制(3/40)及低氧血症(1/40)发生率低于C组(12/40
7/40)(P
<
0.01)
其余不良反应发生率无统计学差异。结论:与丙泊酚相比
右美托咪定用于幼儿气管镜检异物取出术麻醉对呼吸及循环系统功能抑制作用较弱
减少术中呼吸抑制和低氧血症发生率
但可延长麻醉后苏醒时间。
Objective:To evaluate the feasibility of dexmedetomidine in the anesthesia for bronchial foreign body removal and to explore the influence of dexmedetomidine on the circulatory and respiratory function in pediatric patients. Methods:Eighty participants were recruited from July 2013 to November 2015 and were divided randomly into 2 groups(n=40):the dexmedetomidine group(group D)and control group(group C). The anesthesia induction was performed with sevoflurane on all participants. The anesthesia maintenance in the group D was performed with intravenous administration of dexmedetomidine and remifentanil;the anesthesia maintenance in the group C was performed with intravenous administration of propofol and remifentanil. The administration of anesthetics stopped just after the surgery completion. The heart rate(HR)
mean arterial pressure(MAP)
respiration rate was recorded at the following time points:before anesthesia induction(T0)
inserting laryngoscope(T1)
inserting bronchoscope(T2)
5min after bronchoscope insertion(T3)
withdraw bronchoscope(T4)
5min after bronchoscope withdraw(T5)
PACU dicharge(T6). Results:Compared with those of T0
the reduction of HR
MAP
RR at T1-T4 in group D was milder in group C(P<0.01). No difference was found in neither the anesthesia duration and surgery duration[(22.35±4.50)min vs.(22.43±4.70)min]
but the recovery time in group D increased as compared with that in group C(21[16
25] min vs 13[11
15] min
P<0.01);the incidence of intraoperative respiratory depression and hypoxemia was lower in group D(3/40
1/40) than in group C(12/40
7/40)(P <0.01). Conclusion:In pediatric patients undergoing bronchial foreign body removal
as compared with propofol
dexmedetomidine inhibits the circulatory and respiratory function mildly and results in less respiratory depression and hypoxemia
yet it might prolong the recovery time after anesthesia.
右旋美托咪定麻醉气道异物气管镜检呼吸
dexmedetomidineanesthesiaairway foreign bodybronchoscopyrespiration
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