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目的观察先天性心脏病介入治疗术中应用右美托咪定复合七氟醚麻醉的临床效果。方法该院收治的经七氟醚麻醉的先天性心脏病介入治疗患儿60例,将其按照随机对照原则分为观察组和对照组各30例。2组患儿均采用面罩吸入8%七氟醚,氧流量5L/min诱导,2%~4%七氟醚(随心率、血压调整用量)维持麻醉。观察组在七氟醚麻醉维持的基础上静脉泵注右美托咪定行麻醉维持;对照组在七氟醚麻醉维持的基础上静脉泵注生理盐水行麻醉维持。比较2组静脉滴注右美托咪定或生理盐水前(T——0)、静脉滴注后15min(T_1)、苏醒时(T——2)及拔管后5min(T_3)的心率(HR)、平均动脉压(MAP)和苏醒时间以及术后苏醒期间躁动情况。结果 2组患儿麻醉前HR、MAP比较,差异无统计学意义(P>0.05);观察组在T_1、T_2、T_3时段HR、MAP均明显低于对照组,差异均有统计学意义(P<0.05)。2组患儿苏醒时间比较差异无统计学意义(P>0.05)。观察组安静和轻度躁动患者比例高于对照组,重度躁动患者比例低于对照组,差异均有统计学意义(P<0.05)。结论在小儿先天性心脏病介入术中,右美托咪定可有效降低七氟醚全麻苏醒期间的躁动,血流动力学变化较小,麻醉效果好。
Objective To observe the clinical effect of dexmedetomidine combined with sevoflurane anesthesia during interventional therapy of congenital heart disease. Methods Sixty children with congenital heart disease undergoing sevoflurane anesthesia were randomly divided into observation group (30 cases) and control group (30 cases). In both groups, 8% sevoflurane was inhaled with a mask, oxygen flow rate was 5L / min, and 2% ~ 4% sevoflurane (adjusted with heart rate and blood pressure) was maintained. The observation group was treated with intravenous injection of dexmedetomidine on the basis of the maintenance of sevoflurane anesthesia; the control group was maintained by intravenous infusion of saline on the basis of the maintenance of sevoflurane anesthesia. The changes of heart rate (T - 0), intravenous drip (T - 0), intravenous infusion 15 min (T_1), waking time (T - 2) and extubation 5 min HR), mean arterial pressure (MAP) and wake time, and restlessness during postoperative recovery. Results There was no significant difference in HR and MAP between the two groups before anesthesia (P> 0.05). The HR and MAP of the observation group at T 1, T 2 and T 3 were significantly lower than those of the control group (P <0.05). There was no significant difference in recovery time between the two groups (P> 0.05). The proportion of patients with quiet and mild agitation in the observation group was higher than that in the control group, and the proportion of patients with severe agitation was lower than that in the control group (P <0.05). Conclusion During the congenital heart disease intervention in children, dexmedetomidine can effectively reduce the restlessness of sevoflurane during general anesthesia, with little change of hemodynamics and good anesthetic effect.