術(shù)前右美托咪定噴鼻對全憑七氟醚吸入麻醉行腹部外科手術(shù)患兒的腦電雙頻指數(shù)及七氟醚半數(shù)有效濃度的影響

劉超　辛忠

[摘要] 目的 分析術(shù)前右美托咪定噴鼻對全憑七氟醚吸入麻醉行腹部外科手術(shù)患兒的腦電雙頻指數(shù)（BIS）及七氟醚半數(shù)有效濃度[EC（50）]的影響。 方法 選取首都醫(yī)科大學附屬北京兒童醫(yī)院2016年2月～2017年2月接受腹部外科手術(shù)的患兒120例，ASA分級Ⅰ～Ⅱ級，年齡1～3歲，采用隨機數(shù)表法將其分為研究組和對照組，每組60例，分別在麻醉誘導(dǎo)前30 min采用經(jīng)鼻霧化給藥裝置給患兒噴入右美托咪定2 μg/kg和等量的生理鹽水。患兒入手術(shù)室后，面罩加壓給氧，吸入6%七氟烷誘導(dǎo)，意識消失后置入喉罩，按照Dixon序貫實驗給藥，初始濃度為3.50%，下1例患兒七氟醚的設(shè)定根據(jù)上1例患兒喉罩置入的情況調(diào)整。記錄兩組噴鼻前（T0）、噴鼻后20 min（T1）、手術(shù)結(jié)束（T2）、麻醉恢復(fù)時（T3）患兒血壓、心率、BIS值變化及蘇醒期躁動、不良反應(yīng)發(fā)生情況，分析七氟醚喉罩置入時EC（50）與其95%置信區(qū)間（CI）。 結(jié)果 兩組患兒在T0、T1時刻血壓、心率比較差異無統(tǒng)計學意義（P > 0.05），T2、T3時刻研究組患兒血壓、心率均較對照組顯著增快（P < 0.05）；兩組患兒T0時刻BIS值比較差異無統(tǒng)計學意義（P > 0.05），T1、T2時刻研究組患兒BIS值較對照組顯著降低（P < 0.05），T3時刻研究組患兒BIS值顯著高于對照組（P < 0.05）。研究組、對照組患兒七氟醚喉罩置入完成的EC（50）分別為1.35%（95%CI = 1.05%～1.48%）、1.89%（95%CI = 1.77%～2.18%），差異有統(tǒng)計學意義（P < 0.05）。研究組患兒蘇醒期躁動發(fā)生率為5.00%，顯著低于對照組的18.33%（P < 0.05），惡心、嘔吐發(fā)生率為11.67%、6.67%，顯著低于對照組的26.67%、21.67%（P < 0.05）。 結(jié)論 術(shù)前右美托咪定噴鼻可減少腹部外科手術(shù)患兒七氟醚吸入麻醉后躁動，對改善七氟醚吸入麻醉質(zhì)量、七氟醚EC（50）均有積極作用，并可有效減少不良反應(yīng)。

[關(guān)鍵詞] 右美托咪定；七氟醚；吸入麻醉；腦電雙頻指數(shù)；半數(shù)有效濃度

[中圖分類號] R614 [文獻標識碼] A [文章編號] 1673-7210（2017）12（a）-0066-05

[Abstract] Objective To analyze the effects of preoperative intranasal Dexmedetomidine for the bispectral index （BIS） and median effective concentration [EC （50）] of Sevoflurane in children with abdominal surgery by inhalation anesthesia of Sevoflurane. Methods One hundred and twenty children received abdominal surgery in Beijing Children′s Hospital， Capital Medical University from February 2016 to February 2017 were selected， with ASA grading Ⅰ-Ⅱ and 1-3 years old. They were divided into study group and control group by random number table method， with 60 cases in each group， they were respectively given Dexmedetomidine 2 μg/kg and equal amounts of normal saline by nasal aerosolization device at 30 min before anesthesia induction. After the children entered operating room， they were given mask oxygen-inspiration and inhalation of 6% Sevoflurane for anesthesia induction. The laryngeal mask was given after children lost consciousness， and they were given drugs according to Dixon sequential experiment， the initial concentration was 3.50%. The setting of Sevoflurane for the next child was adjusted according to the conditions of laryngeal mask insertion of last one child. The changes of blood pressure， heart rate， BIS and the conditions of emergence agitation， adverse reactions before nasal spray （T0）， 20 min after nasal spray （T1）， and at the end of surgery （T2）， recovery from anesthesia （T3） between the two groups were compared， the EC （50） and 95% confidence interval （CI） at the time of laryngeal mask insertion of Sevoflurane were analyzed. Results There were no significant differences of blood pressure and heart rate at T0 and T1 between the two groups （P > 0.05）. The blood pressure and heart rate of the study group at T2， T3 were significantly higher than those of the control group （P < 0.05）. There was no significant difference of BIS value between the two groups at T0 （P > 0.05）. At T1 and T2， BIS values of the study group were significantly lower than those of the control group （P < 0.05）. At T3， BIS value of the study group was significantly higher than that of the control group （P < 0.05）. The EC （50） at laryngeal mask insertion of Sevoflurane in the study group and the control group was 1.35% （95%CI = 1.05%-1.48%） and 1.89% （95%CI = 1.77%-2.18%）， the differences were statistically significant （P < 0.05）. The incidence of emergence agitation in the study group was 5.00%， which was significantly lower than that of control group （18.33%） （P < 0.05）， the incidence of nausea and vomiting was 11.67%， 6.67% respectively， which was significantly lower than those of control group （26.67%， 21.67%） （P < 0.05）. Conclusion Preoperative intranasal Dexmedetomidine can reduce the agitation after inhalation anesthesia of Sevoflurane in children with abdominal surgery， which has positive effects for improving the quality of inhalation anesthesia of Sevoflurane and EC （50） of Sevoflurane， and it can effectively reduce adverse reactions.endprint

[Key words] Dexmedetomidine； Sevoflurane； Inhalation anesthesia； Bispectral index； Median effective concentration

小兒對陌生環(huán)境及手術(shù)器械具有不同程度的恐懼心理，與父母分離困難，入室時合作性差導(dǎo)致不易配合手術(shù)，往往大多需行全身麻醉；加之小兒解剖系統(tǒng)、生理及病理與成年患者相比有明顯差異，導(dǎo)致小兒外科手術(shù)的麻醉及手術(shù)風險顯著升高，麻醉誘導(dǎo)的實施亦有更高的難度[1]。七氟醚作為吸入麻醉的典型藥物之一，具有誘導(dǎo)時間短、蘇醒快、圍麻醉期血流動力學波動小等特點，在小兒外科手術(shù)麻醉中應(yīng)用廣泛[2]。右美……