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目的观察右美托咪啶对小儿心导管术麻醉维持和苏醒质量的影响。方法将择期进行心导管术的1~11岁儿童随机分为右美托咪啶复合七氟烷组(DS组)41例和七氟烷组(S组)43例。所有患儿均于入室后,静脉注射氯胺酮1 mg·kg-1。DS组静脉泵持续10 min输入复合量的右美托咪啶1μg·kg-1,术中再予维持量2μg·kg-1·h-1,S组用0.9%氯化钠代替。2组术中用脑电双频谱指数(BIS)监测麻醉深度,通过调节七氟烷吸入浓度使BIS值维持在55~65之间。记录2组患儿入室时(T0)、喉罩置入即刻(T1)、喉罩置入后20 min(T2)、喉罩拔除即刻(T3)各时点的心率、平均动脉压、呼吸频率、BIS值、呼气末二氧化碳分压及呼气末七氟烷浓度,记录手术时间、苏醒时间、术后镇静药使用情况及呼吸抑制、恶心、呕吐等不良反应的发生。结果 T1~T3各时点的DS组心率明显低于S组(P<0.01)。T2、T3时点,DS组呼气末七氟烷浓度明显低于S组(P<0.01)。DS组术后苏醒时间明显长于S组(P<0.01)。初醒时点,DS组镇静躁动评分明显低于S组(P<0.01)。术后,DS组躁动需加镇静药例数(12例)明显少于S组(37例),2组比较差异有统计学意义(P<0.01)。结论右美托咪啶能优化小儿心导管术的麻醉维持和苏醒质量。
Objective To observe the effect of dexmedetomidine on the anesthesia maintenance and wakefulness of pediatric cardiac catheterization. Methods One to eleven-year-old children undergoing elective cardioversion were randomly divided into dexmedetomidine composite sevoflurane group (DS group) 41 and sevoflurane group (group S) 43 cases. All infants were injected intravenously with ketamine 1 mg · kg-1. The rats in DS group were given dexmedetomidine (1 μg · kg-1) for 10 min, while the maintenance dose was 2 μg · kg-1 · h-1 in group D. The rats in group S were replaced by 0.9% sodium chloride. In the two groups, the depth of anesthesia was monitored by bispectral index (BIS), and the BIS value was maintained at 55-65 by adjusting the inhalation concentration of sevoflurane. The heart rate, mean arterial pressure and respiratory rate of the two groups at the time of entry (T0), laryngeal mask placement (T1), laryngeal mask placement 20 min (T2), laryngeal mask removal immediately (T3) , BIS value, end-tidal carbon dioxide partial pressure and end-tidal sevoflurane concentration were recorded. The operation time, recovery time, postoperative sedation and respiratory depression, nausea and vomiting were recorded. Results The heart rate of DS group at T1 ~ T3 was significantly lower than that of S group (P <0.01). At T2 and T3, the end-tidal sevoflurane concentration in DS group was significantly lower than that in S group (P <0.01). The recovery time of DS group was significantly longer than that of S group (P <0.01). At wakefulness, the sedation restlessness score of DS group was significantly lower than that of S group (P <0.01). Postoperatively, the number of cases of restlessness plus sedation (12 cases) in DS group was significantly less than that in S group (37 cases). There was significant difference between the two groups (P <0.01). Conclusion Dexmedetomidine optimizes anesthesia maintenance and wakefulness in pediatric cardiac catheterization.