右美托咪定联合舒适性疏导对小儿全麻苏醒期躁动的影响

doi:10.3969/j.issn.1671-7171.2019.02.007

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摘要目的探究右美托咪定联合舒适性疏导对小儿全麻苏醒期躁动的影响。方法前瞻性选择2016年3月至2018年6月本院收治的拟行全麻下腺样体扁桃体切除术的153例患儿纳入本研究。根据随机数表法将其分为右美托咪定组、联合组、对照组,每组各51例。右美托咪定组、联合组均于气管插管后给予右美托咪定泵注(对照组泵注等量生理盐水),联合组于术前加用舒适性疏导。比较三组患儿生理状态变化、拔管后1~4 h Ramsay镇静评分变化以及苏醒时间、躁动评分、躁动发生率。结果三组患儿苏醒后10~60 min时心率(HR)均较苏醒时下降,右美托咪定组苏醒时HR低于对照组,联合组苏醒时HR低于右美托咪定组,差异有统计学意义(P<0.05)。三组患儿拔管后2~4 h时Ramsay评分均较拔管后1 h升高,右美托咪定组拔管后1 h、2 h、4 h Ramsay评分均高于对照组,联合组拔管后1 h、2 h、3 h、4 h Ramsay评分高于右美托咪定组,差异均有统计学意义(P<0.05)。对照组苏醒时躁动评分低于右美托咪定组,右美托咪定组苏醒时躁动评分低于联合组,差异有统计学意义(F=5.879,P=0.000)。对照组躁动发生率为29.41%(15/51)高于右美托咪定组的15.69%(8/51),右美托咪定组躁动发生率亦高于联合组的3.92%(2/51),差异有统计学意义(χ²=3.015,P=0.013)。结论右美托咪定能够在不影响麻醉安全性的前提下,有效预防小儿全麻苏醒期躁动,在此基础上,联合舒适性疏导能够进一步提高躁动的预防效果。

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	张元歌
	毛红平

关键词 ：麻醉药/治疗应用

Abstract：Objective To explore the effect of dexmedetomidine combined with comfort counseling on restlessness during recovery period of general anesthesia in children, and to analyze its clinical application value. Methods One hundred and fifty-four cases of adenoidectomy under general anesthesia in our hospital from March 2016 to June 2018 were selected for prospective control study. The children were divided into dexmedetomidine group, combination group and control group by random number table method, 51 cases in each group. After tracheal intubation, dexmedetomidine group and combination group were given dexmedetomidine pump injection (the control group was pumped with the same amount of saline). The combination group was given comfortable counseling before operation. The changes of physiological state, Ramsay sedation score 1-4 hours after extubation, recovery time, restlessness score and number of restlessness cases were compared among the three groups. The anesthetic effect and safety of different schemes and their effects on restlessness during the recovery period of general anesthesia were analyzed. Results Heart rate (HR) decreased 10 to 60 minutes after awakening in all three groups. HR in the dexmedetomidine group was lower than that in the control group, and HR in the combination group was lower than that in the dexmedetomidine group (P<0.05). Ramsay scores of the three groups at 2~4 hours after extubation were higher than those at 1 hour after extubation. Ramsay scores of the dexmedetomidine group at 1 h, 2 h and 4 h after extubation were higher than those of the control group. Ramsay scores of the combined group at 1 h, 2 h, 3 h and 4 h after extubation were higher than those of the dexmedetomidine group, with statistical significance (P<0.05). The restlessness score of the control group was lower than that of the dexmedetomidine group, and the restlessness score of the dexmedetomidine group was lower than that of the combination group (F=5.879,P=0.000). The incidence of restlessness in the control group was 29.41% (15/51) higher than that in the dexmedetomidine group 15.69% (8/51), and that in the dexmedetomidine group was 3.92% (2/51) higher than that in the combination group (χ² = 3.015,P=0.013).Conclusion Dexmedetomidine can effectively prevent restlessness during the recovery period of general anesthesia in children without affecting the safety of anesthesia. On this basis, combined comfort counseling can further improve the preventive effect of restlessness.

Key words： Anesthetics/TU

收稿日期: 2019-01-04

PACS:

R971.2

通讯作者: E-mail:402548685@qq.com

引用本文:

张元歌, 毛红平. 右美托咪定联合舒适性疏导对小儿全麻苏醒期躁动的影响[J]. 医学临床研究, 2019, 36(2): 230-232.
ZHANG Yuan-ge, MAO Hong-ping. Effect of Dexmedetomidine Combined with Comfort Counseling on Restlessness During Recovery from General Anesthesia in Children. JOURNAL OF CLINICAL RESEARCH, 2019, 36(2): 230-232.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2019.02.007 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2019/V36/I2/230

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