不同剂量右美托咪定复合氯胺酮麻醉在小儿包皮环扎术中的应用

摘要

Objective To evaluate the effect of different doses of dexmedetomidine combined with ketamine in anesthesia for pediatric circumcision.Methods A total of sixty pediatric patients(ASAⅠ-Ⅱgrades,aged from 4 to 12 years old)undergoing circumcision in the Central Hospital of Jiangmen between February 2016 and October 2016 were randomly assigned into three groups(n=20 each):group A:dexmedetomidine 0.5 μg/kg in 10 min after ketamine 1 mg/kg;group B:dexmedetomidine 0.7 μg/kg in 10 min after ketamine 1 mg/kg;group C:normal saline after ketamine 1 mg/kg. Additional 0.5 mg/kg ketamine was given under inadequate anesthesia. During the procedure, mean blood pressure (MAP),heart rate(HR),pulse oxygen saturation(SpO2)were recorded at baseline(T1),the end of infusion(T2),1 min after operation(T3),and the end of operation(T4).The emergence time,agitation rate and adverse reactions during oper-ation were recorded. Results Compared with T1, HR in group A and group B decreased significantly at T2~T4 (P<0.05).At T2-T4,HR and MAP in group A and group B were significantly decreased compared with group C(P<0.05), with statistically significant difference between group A and group B (P<0.05).There was no significant difference in emergence time among three groups:(10±0.9)min in group A,(12±1.5)min in group B,and(12±0.8)min in group C (P>0.05).Compared with group C(10%),group A(0)and group B(0)had significantly reduced agitation rate(P<0.05). Conclusion Dexemedetomidine 0.5 μg/kg combined with ketamine can be used safely in pediatric patients undergoing circumcision.%目的 比较不同剂量右美托咪定复合氯胺酮麻醉在小儿包皮环扎术中的应用效果.方法 选择2016年2月到2016年10月于中山大学附属江门市中心医院行择期包皮环扎术患儿60例,ASAⅠ~Ⅱ级,年龄4~12岁.采用随机数表法分为A、B、C三组,每组20例.患儿术前均开放静脉通道,静脉注射氯胺酮1 mg/kg后入室,随后开始静脉输注右美托咪定,A组输注剂量为0.5μg/kg,B组输注剂量0.7μg/kg,C组静脉输注等量生理盐水,均在10 min输注完毕.输注完成后立即行手术.如患儿术中出现体动分次静脉注射氯胺酮0.5 mg/kg.记录患儿输注右美托咪定前(T1)、输注完成时(T2)、手术开始后1 min(T3)、手术结束时(T4)平均动脉压(MAP)、心率(HR)及脉搏血氧饱和度(SpO2),并记录患儿苏醒体动时间、苏醒躁动率及术中不良反应.结果 与T1比较,A组和B组患儿在T2~T4时点HR明显下降,差异有统计学意义(P<0.05);T2~T4时点,A组和B组患儿HR和MAP较C组明显下降,差异有统计学意义(P<0.05),且A组和B组间差异有统计学意义(P<0.05).与C组相比,A组苏醒时间[(10±0.9)min vs(12± 0.8)min]、B组苏醒时间[(12±1.5)min vs(12±0.8)min]差异均无统计学意义(P>0.05).与C组相比,A组术后躁动发生率(0 vs 10%)和B组术后躁动发生率(0 vs 10%)明显降低,差异均有统计学意义(P<0.05).结论 右美托咪定0.5μg/kg单次静脉输注复合氯胺酮1 mg/kg能为患儿包皮环切术提供良好的麻醉效果且不良反应少.