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目的观察右美托咪定在小儿扁桃体、腺样体切除手术术后围拔管期的镇静作用。方法选择择期进行扁桃体、腺样体切除手术的患儿60例,随机分为常规组(A组)和右美托咪定组(B组)各30例;两组均以丙泊酚和瑞芬太尼靶控输注诱导及维持,手术结束时停药,并静注曲马多2mg/kg。B组手术结束前10min静脉注射右美托咪定0.5μg/kg,输注时间10min。两组均等待患儿自然清醒拔管,观察两组生命体征变化、术后睁眼时间、拔管时间以及苏醒期躁动、上呼吸道梗阻、术后恶心呕吐等情况。结果 B组拔管时和术后清醒时平均动脉压(MAP)和心率(HR)较A组低,差异有统计学意义(P<0.05);B组睁眼时间和拔管时间长于A组,差异有统计学意义(P<0.05);A、B组术后上呼吸道梗阻率分别为6.7%和10.0%,术后恶心呕吐发生率为16.7%和13.3%,差异均无统计学意义;B组苏醒期躁动发生率为10.0%,较A组的30.0%低,差异有统计学意义(P<0.05)。结论右美托咪定在手术围拔管期的应用能较好地用于儿童扁桃体手术术后拔管期的镇静,稳定患儿循环情况,减少苏醒期躁动的发生。
Objective To observe the sedative effect of dexmedetomidine during peri-extubation in children with tonsillectomy and adenoidectomy. Methods Sixty children with tonsillectomy and adenoidectomy were randomly divided into two groups: control group (group A) and dexmedetomidine group (group B), with 30 cases in each group. Propofol and Swiss Fentanyl target-controlled infusion of induction and maintenance, the end of surgery withdrawal, and intravenous tramadol 2mg / kg. Group B received intravenous dexmedetomidine 0.5 μg / kg 10 min before the end of surgery, and the infusion time was 10 min. Two groups were waiting for children naturally awake extubation, observed changes in vital signs, postoperative open eye time, extubation time and recovery of restlessness, upper respiratory tract obstruction, postoperative nausea and vomiting. Results The mean arterial pressure (MAP) and heart rate (HR) in group B at extubation and after awake were lower than those in group A (P <0.05), while those in group B were longer than those in group A (P <0.05). The postoperative upper airway obstruction rates in groups A and B were 6.7% and 10.0%, respectively. The incidences of postoperative nausea and vomiting were 16.7% and 13.3%, respectively, with no significant difference. The incidence of restlessness in group B was 10.0%, which was lower than that in group A (30.0%), the difference was statistically significant (P <0.05). Conclusion The application of dexmedetomidine during the period of extubation can be used to calm the child during extubation in children with tonsil surgery, stabilize the circulatory status of children and reduce the occurrence of restlessness during recovery.