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目的探讨右美托咪定对小儿眼科全凭吸入麻醉中七氟烷最低肺泡有效浓度(minimum alveolar concen-tration,MAC)的影响。方法选择择期行眼科斜视矫正手术患儿60例,年龄4~7岁,ASAⅠ~Ⅱ级。采用随机数字表法将患者随机分为对照组及右美托咪定组,每组30例。入室后监测ECG,HR,SPO_2,BIS等,开放静脉,给予阿托品0.02 mg/kg。两组均采用潮气量呼吸法面罩吸入4 L/min纯氧及7%七氟烷诱导;由同一位熟练掌握喉罩置入技术的麻醉医生置入喉罩,手术全程保留自主呼吸,并给予以下处理:对照组生理盐水10 ml,右美托咪定组将1μg/kg右美托咪定稀释至10 ml经10 min静脉缓慢泵注。10 min后遵循序贯实验的原则设定并调整挥发罐,使两组患者七氟烷呼出浓度达到设定值。手术开始眼部局麻时,观察并记录患儿循环及体动反应等情况。按照等比级设立5个阶梯:3.3%,3.0%,2.7%,2.4%,2.1%。每组首例患者初始呼气末浓度值均为3.0%,如出现体动或HR升高≥15%或BIS≥60,则下一例目标浓度提高一个阶梯;否则视为有效,下一例目标浓度降低一个阶梯。并按照序贯试验的方法计算得出两组MAC并进行比较。结果右美托咪定组MAC为2.57%,95%可信区间CI_B(2.56%,2.59%);对照组测定值2.90%,CI_A(2.89%,2.91%)低11.29%,两组结果差异有统计学意义(P<0.05)。此外,两组呼气末CO_2(P_(ET)CO_2)的数值对照组比右美托咪定组高5.18%,MV,P_(ET)SEV值右美托咪定组比对照组分别降低14.16%,15.26%,且差异有统计学意义(P<0.05)。结论保留自主呼吸的小儿眼科斜视矫正手术全凭吸入麻醉中,使用右美托咪定可显著减少七氟烷用量,其最低肺泡有效浓度降低为2.57%,95%可信区间为2.56%,2.59%。
Objective To investigate the effect of dexmedetomidine on the minimum alveolar concen- tration (MAC) of pediatric ophthalmic anesthesia. Methods Sixty children (aged 4 to 7 years old, ASA Ⅰ ~ Ⅱ) undergoing strabismus surgery were enrolled in this study. Patients were randomly divided into control group and dexmedetomidine group using random number table method, 30 cases in each group. After entering the room to monitor ECG, HR, SPO_2, BIS, etc., open veins, given atropine 0.02 mg / kg. Both groups were induced by inhalation of 4 L / min pure oxygen and 7% sevoflurane with a tidal volume respiration mask. A laryngeal mask was placed in the laryngeal mask by the same anesthesiologist who mastered the laryngeal mask placement technique. The whole procedure retained spontaneous breathing and was given The following treatment: control group, 10 ml of saline, dexmedetomidine group dexmedetomidine 1μg / kg diluted to 10 ml slow intravenous infusion of 10 min. After 10 min, the volatile tank was set and adjusted according to the principle of sequential experiment so that the exhaled concentration of sevoflurane in both groups reached the set value. Eye surgery began to local anesthesia, observation and record of children with circulatory and physical reactions and so on. Five steps are set up on an equal scale: 3.3%, 3.0%, 2.7%, 2.4%, 2.1%. The initial end-tidal concentration was 3.0% for each of the first patients in each group. The target concentration increased by one step in the next case if there was a ≥15% increase in body motion or HR or a BIS ≥60; otherwise, the target concentration Lower a ladder. And in accordance with the sequential test method to calculate the two sets of MAC and compared. Results The dexmedetomidine group had a MAC of 2.57% and a 95% confidence interval of CI_B (2.56%, 2.59%). The control group had a mean of 2.90% and a low 11.29% of CI_A (2.89%, 2.91% Statistical significance (P <0.05). In addition, the values of end-tidal CO 2 (P_ (ET) CO_2) in both groups were 5.18% higher than that of dexmedetomidine group, while MV and P_ (ET) SEV dexmedetomidine groups were 14.16 %, 15.26%, respectively, and the difference was statistically significant (P <0.05). Conclusions Decontamination can significantly reduce the dosage of sevoflurane in pediatric ophthalmological strabismus surgery. The lowest effective alveolar concentration is 2.57%, the 95% confidence interval is 2.56%, 2.59% %.