气管内注射和静脉泵注右美托咪定在小儿全身麻醉苏醒期的应用

doi:10.3877/cma.j.issn.1673-5250.2016.01.010

中华妇幼临床医学杂志(电子版) ›› 2016, Vol. 12 ›› Issue (01) : 56 -61. doi: 10.3877/cma.j.issn.1673-5250.2016.01.010

所属专题：文献；

论著

气管内注射和静脉泵注右美托咪定在小儿全身麻醉苏醒期的应用

余高锋¹, 金尚怡², 陈景晖¹, 赵玉萍¹, 汪自欣¹, 宋兴荣¹^,^*^,^*(

)

^1. 510000　广州市妇女儿童医疗中心麻醉科
^2. 510000　中山大学附属第三医院岭南医院心血管科

收稿日期:2015-12-08 修回日期:2016-01-05 出版日期:2016-02-01
通信作者: 宋兴荣

Intravenous and endotracheal application of dexmedetomidine during recovery period of pediatric general anesthesia

Gaofeng Yu¹, Shangyi Jin², Jinghui Chen¹, Yuping Zhao¹, Zixin Wang¹, Xingrong Song¹()

^1. Department of Anesthesia, Guangzhou Women and Children's Medical Center, Guangzhou 510000, Guangdong Province, China
^2. Department of Cardiovascular, Third Affiliated Hospital of Sun Yat-sen University-Lingnan Hospital, Guangzhou 510000, Guangdong Province, China

Received:2015-12-08 Revised:2016-01-05 Published:2016-02-01
Corresponding author: Xingrong Song
About author:
Corresponding author: Song Xingrong, Email: songxingrong010@126.com

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引用本文：

余高锋, 金尚怡, 陈景晖, 赵玉萍, 汪自欣, 宋兴荣. 气管内注射和静脉泵注右美托咪定在小儿全身麻醉苏醒期的应用[J/OL]. 中华妇幼临床医学杂志(电子版), 2016, 12(01): 56-61.

Gaofeng Yu, Shangyi Jin, Jinghui Chen, Yuping Zhao, Zixin Wang, Xingrong Song. Intravenous and endotracheal application of dexmedetomidine during recovery period of pediatric general anesthesia[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2016, 12(01): 56-61.

目的

探讨气管内注射和静脉泵注右美托咪定在气管插管全身麻醉患儿苏醒期气管拔管中的应用。

方法

选择2014年12月至2015年5月于广州市妇女儿童医疗中心拟在气管插管全身麻醉下择期行下肢或腹部手术的120例患儿为研究对象，由电脑生成随机数据表，按照手术先后顺序，将其分为V组(n＝40，经静脉泵注右美托咪定)、T组(n＝40，气管内注射右美托咪定)和对照组(n＝40，静脉注射生理盐水)。本研究遵循的程序符合广州市妇女儿童医疗中心伦理委员会所制定的伦理学标准，得到该委员会批准(穗妇儿药研伦审批字[2015]第10号)，分组征得受试对象监护人的知情同意，并与之签署临床研究知情同意书。3组患儿年龄、性别、体重比较，差异无统计学意义(P>0.05)。观察3组患儿在全身麻醉苏醒期不同观察时间点的血压(包括收缩压和舒张压)、心率、唤醒时间、气管拔管时间及呛咳反应评分。

结果

①在T2观察时间点，T组患儿的心率较对照组患儿降低，两组比较，差异有统计学意义(P<0.05)。在T3观察时间点，T组患儿的收缩压、舒张压和心率均较对照组降低，并且T组患儿的舒张压和心率也低于V组，T组分别与后二者比较，差异均有统计学意义(P<0.01)。在T4～T7观察时间点，V组和T组患儿的收缩压、舒张压和心率均低于对照组，差异有统计学意义(P<0.05)。在T4、T5观察时间点，T组患儿的心率低于V组，两组比较，差异有统计学意义(P<0.05)。②V组和T组患儿唤醒时间均较对照组延长，前二者分别与后者比较，差异有统计学意义(P<0.05)。T组患儿唤醒时间显著短于V组，两组比较，差异有统计学意义(P<0.05)。T组气管拔管时间显著短于V组，两组比较，差异也有统计学意义(P<0.05)。③V组和T组气管拔管时呛咳反应评分低于对照组，差异有统计学意义(P<0.05)。

结论

气管内注射和静脉泵注右美托咪定对气管插管全身麻醉患儿苏醒期气管拔管时的血压和心率有良好的稳定效果，并能有效抑制气管因机械刺激引起的呛咳反应。静脉泵注右美托咪定会延长患儿唤醒时间及气管拔管时间。气管内注射右美托咪定会延长患儿唤醒时间，但不影响气管拔管时间。

关键词: 右美托咪定, 麻醉恢复期, 注射，气管内, 输注泵, 儿童

Objective

To explore intravenous and endotracheal application of dexmedetomidine during recovery period of pediatric general anesthesia.

Methods

From December 2014 to May 2015, a total of 120 children underwent elective lower limb or abdominal surgery under general anesthesia in Guangzhou Women and Children＇s Medical Center were enrolled in the study. According to random digital table and the order of admission, they were divided into group V (n=40, dexmedetomidine was given intravenously), group T (n=40, dexmedetomidine was used intratracheally) and control group (n=40, normal saline was given intravenously). The study protocol was approved by the Ethical Review Board of Investigation in Human being of Guangzhou Women and Children's Medical Center. Informed consent was obtained from each participants' parents. There were no significant differences among three groups in age, gender and weight (P>0.05). The systolic and diastolic blood pressure, heart rate, recovery time were compared among three groups at different time points.The extubation time and bucking response were also compared among them.

Results

①At T2, heart rate of group T was lower than that of control group, and the difference was significant(P<0.05). At T3, systolic blood pressure, diastolic blood pressure, and heart rate in group T were lower than those of control group, the diastolic blood pressure and heart rate in group T also lower than those of group V, and the differences above were significant (P<0.01). From T4 to T7, systolic blood pressure, diastolic blood pressure and heart rate in group T and group V were lower than those of control group, respectively, which with significant differences (P<0.05). At T4 and T5, there were significant difference in heart rate between group T and group V(P<0.05). ② Compared with control group, recovery time of group V and group T were prolonged, and the differences were significant, respectively (P<0.05). Significant difference was found in recovery time between group V and group T (P<0.05). Extubation time in group V was longer than that of control group (P<0.05). ③ The bucking score of group V and group T were significantly lower than that of control group, respectively, and the differences were significant(P<0.01).

Conclusions

The intravenous and endotracheal application of dexmedetomidine were helpful to maintain circulation stabilization. They could alleviate bucking response during recovery period of pediatric general anesthesia. The recovery time and extubation time were prolonged when dexmedetomidine was administered intravenously. Dexmedetomidine injected intratracheally did not affect extubation time, but prolonged the recovery time.

Key words: Dexmedetomidine, Anesthesia recovery period, Injection intratracheal, Infusion pumps, Child

表1 3组患儿不同观察时间点收缩压比较(mmHg，±s)

组别	例数	T1	T2	T3	T4	T5	T6	T7
V组	40	87.6±4.8	76.8±4.5	76.7±6.1^a	76.3±5.3^a	78.5±4.9^a	85.0±4.0^a	80.7±3.7^a
T组	40	87.6±4.1	76.3±5.0	76.2±6.8^a	77.8±5.9^a	80.6±5.0^a	83.6±3.4^a	86.0±3.3^a
对照组	40	86.9±4.0	77.4±4.5	78.8±4.8	84.9±4.9	94.3±5.2	105.5±5.1	95.4±3.8
F值		0.33	0.48	24.15	28.86	116.83	339.37	170.83
P值		>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表1 3组患儿不同观察时间点收缩压比较(mmHg，±s)

组别	例数	T1	T2	T3	T4	T5	T6	T7
V组	40	87.6±4.8	76.8±4.5	76.7±6.1^a	76.3±5.3^a	78.5±4.9^a	85.0±4.0^a	80.7±3.7^a
T组	40	87.6±4.1	76.3±5.0	76.2±6.8^a	77.8±5.9^a	80.6±5.0^a	83.6±3.4^a	86.0±3.3^a
对照组	40	86.9±4.0	77.4±4.5	78.8±4.8	84.9±4.9	94.3±5.2	105.5±5.1	95.4±3.8
F值		0.33	0.48	24.15	28.86	116.83	339.37	170.83
P值		>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表2 3组患儿不同观察时间点舒张压比较(mmHg,±s)

组别	例数	T1	T2	T3	T4	T5	T6	T7
V组	40	49.6±5.3	44.1±4.6	40.8±4.9	35.9±3.8^a	38.7±3.1^a	53.4±4.9^a	45.3±4.5^a
T组	40	51.3±5.7	43.4±5.6	36.2±5.1^ab	35.0±3.2^a	37.9±3.5^a	51.8±5.6^a	46.4±5.2^a
对照组	40	51.5±4.9	43.0±4.2	42.8±4.3	47.1±3.7	51.3±3.2	62.9±5.0	56.6±4.7
F值		15.56	0.48	20.20	143.05	212.77	53.64	66.83
P值		>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表2 3组患儿不同观察时间点舒张压比较(mmHg,±s)

组别	例数	T1	T2	T3	T4	T5	T6	T7
V组	40	49.6±5.3	44.1±4.6	40.8±4.9	35.9±3.8^a	38.7±3.1^a	53.4±4.9^a	45.3±4.5^a
T组	40	51.3±5.7	43.4±5.6	36.2±5.1^ab	35.0±3.2^a	37.9±3.5^a	51.8±5.6^a	46.4±5.2^a
对照组	40	51.5±4.9	43.0±4.2	42.8±4.3	47.1±3.7	51.3±3.2	62.9±5.0	56.6±4.7
F值		15.56	0.48	20.20	143.05	212.77	53.64	66.83
P值		>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表3 3组患儿不同观察时间点心率比较(次/min,±s)

组别	例数	T1	T2	T3	T4	T5	T6	T7
V组	40	127.9±7.3	112.1±6.9	100.4±5.9^a	101.1±4.5^a	99.5±5.7^a	101.1±5.7^a	91.0±4.5^a
T组	40	128.2±7.1	107.7±7.6^a	97.5±6.5^ab	97.1±6.5^a	102.6±6.5^a	102.9±6.0^a	91.1±4.5^a
对照组	40	129.3±7.7	124.5±6.4	121.0±6.3	126.9±5.3	126.4±5.6	134.2±5.2	116.3±5.9
F值		0.42	32.63	167.95	346.23	246.89	431.32	337.74
P值		>0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表3 3组患儿不同观察时间点心率比较(次/min,±s)

组别	例数	T1	T2	T3	T4	T5	T6	T7
V组	40	127.9±7.3	112.1±6.9	100.4±5.9^a	101.1±4.5^a	99.5±5.7^a	101.1±5.7^a	91.0±4.5^a
T组	40	128.2±7.1	107.7±7.6^a	97.5±6.5^ab	97.1±6.5^a	102.6±6.5^a	102.9±6.0^a	91.1±4.5^a
对照组	40	129.3±7.7	124.5±6.4	121.0±6.3	126.9±5.3	126.4±5.6	134.2±5.2	116.3±5.9
F值		0.42	32.63	167.95	346.23	246.89	431.32	337.74
P值		>0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表4 3组患儿唤醒时间和气管拔管时间比较(min,±s)

组别	例数	唤醒时间	气管拔管时间
V组	40	24.6±3.2^a	23.5±2.7
T组	40	21.7±3.3^{a b}	18.4±2.2^a
对照组	40	20.3±2.8	17.6±2.1
F值		19.55	76.06
P值		<0.01	<0.01

表4 3组患儿唤醒时间和气管拔管时间比较(min,±s)

组别	例数	唤醒时间	气管拔管时间
V组	40	24.6±3.2^a	23.5±2.7
T组	40	21.7±3.3^{a b}	18.4±2.2^a
对照组	40	20.3±2.8	17.6±2.1
F值		19.55	76.06
P值		<0.01	<0.01

表5 3组患儿呛咳反应评分比较(分，±s)

组别	例数	呛咳评分
V组	40	1.71±0.8^a
T组	40	1.8±0.7^a
对照组	40	2.2±0.8
F值		5.52
P值		<0.01

表5 3组患儿呛咳反应评分比较(分，±s)

组别	例数	呛咳评分
V组	40	1.71±0.8^a
T组	40	1.8±0.7^a
对照组	40	2.2±0.8
F值		5.52
P值		<0.01

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Intravenous and endotracheal application of dexmedetomidine during recovery period of pediatric general anesthesia

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Intravenous and endotracheal application of dexmedetomidine during recovery period of pediatric general anesthesia