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目的评价右美托咪定辅助喉罩用于患儿短小手术的效果。方法择期行单侧鞘状突高位结扎术患儿60例,美国麻醉师协会)ASA)Ⅰ或Ⅱ级,2~5岁,采用随机数字表法,将患儿分为3组(n=20):右美托咪定辅助喉罩组(D组)和咪唑安定辅助喉罩组(M组)和氯胺酮联合骶麻组(K组)。于麻醉诱导前约10 min由家长陪同进入麻醉准备室,静脉滴注阿托品0.01 mg/kg,分别于5 min内泵注右美托咪定0.5μg/kg、咪达唑仑0.1 mg/kg、氯胺酮2 mg/kg。D组、M组采用异丙酚-芬太尼诱导,喉罩吸入七氟醚维持麻醉;K组静注丙泊酚后行骶管阻滞。3组术中均保留自主呼吸。记录各时间点的心率(HR)变化,苏醒期躁动,苏醒时间和不良反应。结果 3组组内各时间点与T0时比较,T1~T4时M组、K组HR明显升高(P<0.05);与D组比较,T1~T4时M组、K组HR亦明显升高(P<0.05),M组苏醒期躁动发生率明显增高,苏醒时间明显延长(P<0.05),K组术中体动、气道辅助处理发生率明显增高,苏醒时间明显延长(P<0.05)。结论将右美托咪定辅助喉罩用于小儿短小手术,术中呼吸平稳,血流动力学稳定,术后苏醒迅速,不良反应少,安全可靠。
Objective To evaluate the effect of dexmedetomidine-assisted laryngeal mask for short-term surgery in children. Methods Sixty children with unilateral sheath herniation ligation were randomly divided into 3 groups (n = 20), ASA Ⅰ or Ⅱ, aged 2 to 5 years old. ): Dexmedetomidine-assisted laryngeal mask group (group D) and midazolam-assisted laryngeal mask group (group M) and ketamine combined with sacral anesthesia group (group K). About 10 minutes before the induction of anesthesia, accompanied by their parents into the anesthesia preparation room, atropine 0.01 mg / kg intravenous infusion of dexmedetomidine 0.5μg / kg, midazolam 0.1 mg / kg, Ketamine 2 mg / kg. Groups D and M were induced with propofol-fentanyl, and sevoflurane was inhaled into the laryngeal mask to maintain anesthesia. Group K was given intravenous propofol followed by caudal block. Three groups of patients were to maintain spontaneous breathing. The changes of heart rate (HR), wakefulness recovery, recovery time and adverse reactions at each time point were recorded. Results Compared with T0 at each time point, the HR of M group and K group increased significantly at T1 ~ T4 (P <0.05). Compared with D group, the HR of M group and K group increased significantly at T1 ~ T4 (P <0.05). The incidence of agitation in M group was significantly higher than that in M group (P <0.05), and the recovery time was significantly longer in K group (P < 0.05). Conclusion The dexmedetomidine-assisted laryngeal mask is used for short pediatric surgery. It has stable intraoperative breathing, stable hemodynamics, rapid postoperative recovery, few adverse reactions, and is safe and reliable.