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目的探讨右旋美托咪定在急诊婴幼儿气管异物取出术麻醉中的应用。方法选择8个月至3岁拟急诊行左侧或右侧支气管异物取出术的患儿60例,随机分为右美托咪定组(D)及对照组(C),每组30例。麻醉方法:(1)诱导:两组均缓慢静脉注射芬太尼1μg/kg。D组静脉泵入首剂量右旋美托咪定1μg1/kg,10 min内输注完成;C组静脉注射丙泊酚3 mg/kg。面罩吸入8%七氟醚(6 L/min),提下颌患儿无体动后开始手术;(2)维持:D组右旋美托咪定改为1μg-1·kg-1·h-1静脉持续恒速输注,C组七氟醚吸入麻醉;(3)术毕:停用右旋美托咪定或七氟醚,保留自主呼吸送入麻醉恢复室,患儿醉清醒后回病房。记录每例患儿的诱导时间、不同时间点的生命体征情况、术中特殊事件的发生和处理方法以及苏醒时间。结果与入室时相比,D组使用右旋美托咪定后5 min心率、血压降低[HR(133.5±2.6)次/分vs(102±10.4)次/min,SBP(108.9±2.6)mmHg vs(89.3±6.6)mmHg],差异有统计学意义(P<0.05);呼吸频率、SPO_2比较,差异无统计学意义(P>0.05)。置入硬支气管镜时、异物取出时,D组生命体征较前无明显变化(P>0.05);但与C组相比心率及血压降低(P<0.05)。D组与C组患儿支气管痉挛的发生率分别为6.7%和10%,差异无统计学意义(χ~2=0.220,P>0.05)。两组平均苏醒时间分别为(30.5±5.4)min和(18.9±4.4)min,差异有统计学意义(t=7.000,P<0.05)。结论右旋美托咪定能够安全、有效地应用于婴幼儿气管异物取出术麻醉中。
Objective To investigate the application of dexmedetomidine in anesthesia of emergency tracheal foreign body removal in infants and children. Methods Sixty children with left or right bronchus foreign body removal during the emergency department of 8 months to 3 years were randomly divided into dexmedetomidine group (D) and control group (C), 30 cases in each group. Methods of Anesthesia: (1) Induction: Fentanyl 1 μg / kg was given intravenously in both groups. Group D received intravenous infusion of the first dose of dexmedetomidine 1μg1 / kg, infusion completed within 10 min; Group C intravenous injection of propofol 3 mg / kg. The mask was inhaled with 8% sevoflurane (6 L / min), and the mandibular jaw children were given the operation without body motion. (2) Maintenance: The dexmedetomidine in group D was changed to 1 μg-1 · kg-1 · h- 1 intravenous infusion of constant velocity, C group sevoflurane inhalation anesthesia; (3) surgery: disable dexmedetomidine or sevoflurane, to maintain spontaneous breathing into the anesthesia recovery room, children drunk awake Ward. Record each child induction time, vital signs at different time points, the occurrence and treatment of special events and the recovery time. Results In group D, the heart rate and blood pressure were decreased 5 min after dexmedetomidine administration (HR (133.5 ± 2.6) / min vs (102 ± 10.4) / min, SBP (108.9 ± 2.6) mmHg vs (89.3 ± 6.6) mmHg], the difference was statistically significant (P <0.05); respiratory rate, SPO_2 comparison, the difference was not statistically significant (P> 0.05). When placed in a hard bronchoscope, the vital signs in group D had no significant changes (P> 0.05) when the foreign body was removed; but compared with group C, the heart rate and blood pressure decreased (P <0.05). The incidence of bronchospasm in group D and group C was 6.7% and 10%, respectively, with no significant difference (χ ~ 2 = 0.220, P> 0.05). The average recovery time of the two groups were (30.5 ± 5.4) min and (18.9 ± 4.4) min, respectively, the difference was statistically significant (t = 7.000, P <0.05). Conclusion Dexmedetomidine can be safely and effectively applied to the removal of tracheal foreign bodies in infants and young children.