本文選題：右美托咪定 + 氯胺酮　； 參考：《重慶醫(yī)科大學(xué)學(xué)報(bào)》2017年12期

【摘要】：目的:觀察右美托咪定聯(lián)合氯胺酮滴鼻用于小兒術(shù)前鎮(zhèn)靜的效果及安全性。方法:選擇于我院2016年3至6月擬行腭咽成形術(shù)、扁桃體摘除術(shù),美國(guó)麻醉師協(xié)會(huì)(American Society of Anesthesiologists,ASA)I~Ⅱ級(jí),年齡2~6歲的患兒155例,隨機(jī)分為4組:D1組(n=37)和D2組(n=40)分別接受右美托咪定1μg/kg或2μg/kg滴鼻;D1+K組(n=38)及D2+K(n=40)組均接受1μg/kg或2μg/kg右美托咪定滴鼻,同時(shí)另一鼻孔行1 mg/kg氯胺酮滴鼻,40 min后轉(zhuǎn)送入手術(shù)室,接受全身麻醉,術(shù)畢送入復(fù)蘇室。滴鼻后每15 min記錄患兒的心率(heart rate,HR)、平均動(dòng)脈血壓(mean arterial pressure,MAP)及血氧飽和度(oxygen saturation,SpO_2),記錄準(zhǔn)備轉(zhuǎn)運(yùn)到手術(shù)室時(shí)(T1)及麻醉誘導(dǎo)時(shí)(T2)改良鎮(zhèn)靜評(píng)分(modified observer's assessment of alertness/sedation score,m OAAS),記錄鎮(zhèn)靜起效時(shí)間、手術(shù)時(shí)間、麻醉時(shí)間、蘇醒時(shí)間、蘇醒期躁動(dòng)評(píng)分(pediatric anesthesia emergence delirium scale,PAED)、術(shù)后疼痛評(píng)分(face,legs,activity,crying,consolability scale,FLACC)及不良事件發(fā)生情況等。結(jié)果:4組患兒一般情況及麻醉時(shí)間、手術(shù)時(shí)間均無(wú)差異;D2+K組與其余3組(D1、D2、D1+K)比較鎮(zhèn)靜起效時(shí)間顯著縮短(P0.05);T1及T2時(shí)間點(diǎn)D2+K組與其余3組(D1、D2、D1+K)比較鎮(zhèn)靜成功率明顯升高(P0.01);D2組心動(dòng)過(guò)緩發(fā)生率較其余3組顯著升高(P0.05),4組患兒蘇醒時(shí)間、蘇醒期躁動(dòng)評(píng)分、術(shù)后疼痛評(píng)分無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論:右美托咪定與氯胺酮聯(lián)合用藥提高了術(shù)前鎮(zhèn)靜的成功率,縮短鎮(zhèn)靜起效時(shí)間,是一種安全有效、方便易行的小兒術(shù)前用藥方法。
[Abstract]:Objective: To observe the effect and safety of dexmedetomidin combined with ketamine intranasal for children's sedation. Methods: selected in our hospital from 3 to June 2016, palatopalatyngoplasty, tonsillectomy, American Society of Anesthesiologists, ASA I~ II, and 155 children aged 2~6, randomly divided into 4 groups: D1 (n=) 37) and group D2 (n=40) received dexmedetomidine 1 g/kg or 2 g/kg dripping nose, D1+K group (n=38) and D2+K (n=40) group received 1 u g/kg or 2 mu dexmedetomidin nose drops, while the other nose bore 1 mg/kg ketamine nose drops, 40 min was transferred into the operation room, received whole body drunken and sent to the resuscitation room. Eart rate, HR), the mean arterial blood pressure (mean arterial pressure, MAP) and blood oxygen saturation (oxygen saturation, SpO_2). Record the preparation for the delivery to the operation room (T1) and the induction of anesthesia induction (T2), to record the time of the sedative effect, the time of operation, and the time of anesthesia. The awakening time, pediatric anesthesia emergence delirium scale, PAED, postoperative pain score (face, legs, activity, crying, consolability scale) and the occurrence of adverse events. Results: there was no difference in the general condition of the 4 groups and the time of anesthesia and the operation time. Sedative onset time was significantly shortened (P0.05); T1 and T2 time point D2+K group compared with the other 3 groups (D1, D2, D1+K), the rate of sedation success was significantly higher (P0.01); the occurrence rate of bradycardia in the D2 group was significantly higher than the other 3 groups (P0.05), the 4 groups of children awakening time, the restless evaluation of the awakening period, and no statistical difference in postoperative pain scores. Conclusion: right metomomidin and chloramine Ketone combination can improve the success rate of sedation before operation and shorten the onset time of sedation. It is a safe, effective and convenient method for pre-operative medication in children.
【作者單位】： 重慶醫(yī)科大學(xué)附屬兒童醫(yī)院麻醉科兒童發(fā)育疾病研究教育部重點(diǎn)實(shí)驗(yàn)室兒童發(fā)育重大疾病國(guó)家國(guó)際科技合作基地兒科學(xué)重慶市重點(diǎn)實(shí)驗(yàn)室;
【分類號(hào)】：R726.1

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