本文選題：右美托咪定 + 靜吸復(fù)合麻醉��； 參考：《藥品評價》2016年15期

【摘要】：目的:探究分析右美托咪定輔助下靜吸復(fù)合麻醉應(yīng)用于小兒氣管異物取出術(shù)的效果。方法:選2015年6月至2016年6月贛州市人民醫(yī)院收治的90例行支氣管鏡檢術(shù)患兒,隨機平均分作三組:P組(丙泊酚+瑞芬太尼+表面麻醉)、D組(右美托咪定+丙泊酚+瑞芬太尼+表面麻醉)、L組(喉罩+丙泊酚+瑞芬太尼+右美托咪定)�；純喝胧液蠼�(jīng)面罩吸入七氟醚5min,之后用2%利多卡因?qū)夤軆?nèi)、咽喉部與舌根部行表面麻醉。在此基礎(chǔ)上給予P組患兒靜脈泵入瑞芬太尼0.1μg/(kg·min)、丙泊酚0.15mg/(kg.min)維持麻醉至手術(shù)結(jié)束。對于D組則在表面麻醉后將右美托咪定經(jīng)微量泵按2μg/kg的負荷劑量以恒定速度在10min內(nèi)泵完,其后將泵速調(diào)整為1μg/(kg·h),于此同時在表面麻醉后靜脈泵入瑞芬太尼0.075μg/(kg·min)、丙泊酚0.075mg/(kg.min)維持麻醉至手術(shù)結(jié)束。L組與D組麻醉方式相同,但是在術(shù)前2mim可彎曲喉罩,各組均于表面麻醉15min后開始進行手術(shù)操作。比較三組各時刻麻醉誘導(dǎo)前(T_0)、表面麻醉后15min(T_1)、置鏡后1min(T_2)、置鏡后5min(T_3)患者的心率(heart rate,HR)、呼吸頻率(respiratory rate,RR)、脈搏氧飽和度(SpO_2)、平均動脈壓(mean arterial pressure,MAP),比較麻醉開始后、術(shù)中及術(shù)后不良反應(yīng)包括呼吸抑制、惡心、心動過速、喉痙攣、心動過緩、躁動、嗆咳等的發(fā)生率,觀察經(jīng)可彎曲喉罩行硬質(zhì)支氣管鏡氣管異物取出的成功率。在HR、RR、SpO_2、MAP的組間比較時,T_0時刻三組兩兩比較差異無統(tǒng)計學(xué)意義(P0.05),T_1、T_2、T_3時刻,P組與D組、L組比較差異有統(tǒng)計學(xué)意義(P0.05)。在HR、RR、SpO_2、MAP的組內(nèi)比較時,除T_2與T_3時刻比較差異無統(tǒng)計學(xué)意義(P0.05),其余時刻兩兩比較差異有統(tǒng)計學(xué)意義(P0.05)。三組患兒麻醉過程中及術(shù)中、術(shù)后不良反應(yīng)發(fā)生率的比較,D組與L組比較差異無統(tǒng)計學(xué)意義(P0.05),P組與D組、L組嗆咳、呼吸抑制的比較差異有統(tǒng)計學(xué)意義(P0.05)。經(jīng)可彎曲喉罩行硬質(zhì)支氣管鏡氣管異物取出的成功率為50%,其中主氣管異物8例,右支氣管異物4例,左支氣管異物3例。結(jié)論:右美托咪定輔助的靜吸復(fù)合麻醉應(yīng)用于小兒氣管異物取出術(shù)呼吸、循環(huán)系統(tǒng)相對穩(wěn)定,不良反應(yīng)的發(fā)生率較低,是一種較為安全、可行的硬質(zhì)支氣管鏡氣管異物取出術(shù)的麻醉方法。經(jīng)可彎曲喉罩的硬質(zhì)支氣管鏡氣管異物取出術(shù)成功率不高,主要適用于主氣管的異物取出術(shù)。
[Abstract]:Objective: to investigate the effect of dexmetomidine-assisted combined intravenous anesthesia on trachea foreign body removal in children. Methods: from June 2015 to June 2016, 90 children with bronchoscopy were selected from Ganzhou people's Hospital. They were randomly divided into three groups: propofol remifentanil topical anesthesia group D (dexmetomidine propofol remifentanil topical anesthesia) group L (laryngeal mask propofol remifentanil dexmetromidine). Sevoflurane was inhaled by mask for 5 min, and then 2% lidocaine was used to anesthetize the trachea, throat and tongue. On this basis, group P was given intravenous infusion of remifentanil 0.1 渭 g/(kg, propofol 0.15 mg / min) to maintain anesthesia until the end of the operation. For group D, after topical anesthesia, dexmetidine was pumped in 10min at a constant speed of 2 渭 g/kg at a loading dose of 2 渭 g/kg. Then, the pump speed was adjusted to 1 渭 g/(kg 路min. After surface anesthesia, remifentanil was injected intravenously into remifentanil (0.075 渭 g/(kg 路min), propofol 0.075 mg / kg 路min). The anesthesia of group L was the same as that of group D until the end of operation, but the larynx mask could be bent by 2mim before operation. All groups were operated after surface anesthesia of 15min. The heart rate, respiratory rate, pulse oxygen saturation and mean arterial pressure were compared between the three groups before anesthesia induction, 15 min after anesthesia, 1 min after anesthesia, 5 min after endoscopy, 5 min after endoscopy.) after anesthesia, the heart rate, respiratory rate, oxygen saturation, oxygen saturation and mean arterial pressure were compared between the three groups. The adverse reactions included respiratory depression, nausea, tachycardia, laryngeal spasm, bradycardia, restlessness, cough and so on. There was no significant difference between the three groups at the time of T _ 0. There was no significant difference between P _ (0.05) and T _ (1) T _ (2) T _ (3). There was significant difference between P group and D group (P 0.05). There was no significant difference between T _ 2 and T _ 3 in the group of RRSpO2MAP, but there was a significant difference in the other two moments (P 0.05). Comparison of the incidence of adverse reactions during anesthesia and during operation in the three groups there was no significant difference between group D and group L. there was no significant difference between group D and group D in choking cough and respiratory inhibition in group D (P 0.05) and group D (P 0.05). The successful rate of tracheal foreign body removal by flexible laryngeal mask was 50%, including 8 cases of main tracheal foreign body, 4 cases of right bronchus foreign body and 3 cases of left bronchial foreign body. Conclusion: dexmetomidine-assisted combined intravenous anesthesia is a safe method for the removal of trachea foreign bodies in children, the circulatory system is relatively stable and the incidence of adverse reactions is relatively low. A feasible anesthetic method for removing foreign body from trachea by rigid bronchoscope. The successful rate of tracheobronchial foreign body removal with flexible laryngeal mask is not high, which is mainly suitable for the removal of foreign body from the main trachea.
【作者單位】： 贛州市人民醫(yī)院麻醉科;
【基金】：江西省衛(wèi)生計生委科技計劃(編號:20167215)
【分類號】：R726.1

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