右美托咪定不同時間給藥在小兒斜視矯正術中的應用

劉晶瑩 蘇小虎 吳磊 田宇峰 吳浩

[摘要] 目的 探討右美托咪定不同時間給藥對患兒術后躁動、眼心反射及惡心嘔吐發生率的影響。 方法 選取2017年5月至2020年7月我院斜視手術的患兒90例，按照隨機數字表法將患兒分為A組、B組和C組，每組各30例，A組給予的5 mL 0.9%氯化鈉注射液。B組在麻醉誘導時給予右美托咪定0.5 μg/kg（10 min泵注完畢），C組手術結束眼肌操作后給予右美托咪定0.5 μg/kg（10 min泵注完畢），記錄三組患兒手術時間、拔管時間、麻醉后恢復室（PACU）停留時間，對比三組患兒拔管后0、15、30 min躁動評分（PAED）、Ramsay鎮靜評分、眼心反射發生率、惡心嘔吐的發生率和右美托咪定補救次數。 結果 三組患兒性別、年齡、體重和手術時間比較，差異無統計學意義（P>0.05）。C組拔管時間（15.55±3.34）min、PACU停留時間（43.25±10.86）min，長于A組（9.07±2.21）min、（31.27±8.43）min和B組（9.38±2.54）min、（32.43±7.36）min，差異有統計學意義（P<0.05）。A組拔管后0 min PAED評分為（11.21±2.73）分、15 min（6.72±2.21）分，高于B組（7.54±2.21）分、（2.66±0.54）分和C組（6.95±2.12）分、（2.54±0.73）分，差異有統計學意義（P<0.05）。B組拔管后0 min Ramsay鎮靜評分為（3.61±0.53）分，C組拔管后0 min Ramsay鎮靜評分為（3.75±0.83）分，均高于A組的（2.53±0.81）分，差異有統計學意義（P<0.05）。B組眼心反射發生率為80.00%，明顯高于A組（56.67%）和C組（60.00%），差異有統計學意義（P<0.05）。A組惡心嘔吐發生率為66.67%，明顯高于B組（33.33%）和C組（43.33%），差異有統計學意義（P<0.05）。A組右美托咪定補救次數（18例）明顯高于B組（3例）和C組（0例），差異有統計學意義（P<0.05）。 結論 小兒斜視手術在眼肌操作結束后應用單劑量的右美托咪定可降低術后躁動的發生率，而不增加眼心反射的發生。

[關鍵詞] 斜視手術;右美托咪定;術后躁動;眼心反射

[中圖分類號] R614? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）24-0145-04

Application of dexmedetomidine administered at different times in pediatric strabismus surgery

LIU Jingying? ?SU Xiaohu? ?WU Lei? ?TIAN Yufeng? ?WU Hao

Department of Anesthesiology， Suqian First People′s Hospital Affiliated to Nanjing Medical University， Suqian? ?223800， China

[Abstract] Objective To explore the effects of dexmedetomidine administered at different times on the incidence of postoperative agitation， oculocardiac reflex and nausea and vomiting in children. Methods A total of 90 children who underwent strabismus surgery in our hospital from May 2017 to July 2020 were evenly divided into group A， B and C（n=30） by using the random number table method. Group A was given 5 mL of 0.9% sodium chloride injection， group B was given dexmedetomidine 0.5 μg/kg at the induction of anesthesia （with a pumping completion time of 10 min）， and group C was given dexmedetomidine 0.5 μg/kg （with a pumping completion time of 10 min） at the end of surgery after eye muscle operation. The of three groups time of surgery， time of extubation， and length of stay in the postanesthesia care unit （PACU） were recorded. The agitation scores at 0， 15 and 30 min after extubation PAED， Ramsay sedation score， incidence of oculocardiac reflex， incidence of nausea and vomiting， and number of dexmedetomidine remedies of three groups were compared. Results There were no statistically significant differences in gender ratio， age， weight and surgery time among the three groups（P>0.05）.The time of extubation （15.55±3.34）min and length of stay in PACU （43.25±10.86）min in group C were longer than those in group A （9.07±2.21） min， （31.27±8.43） min and group B （9.38±2.54） min， （32.43±7.36） min，with statistically significant differences （P<0.05）. The PAED scores at 0 min （11.21±2.73）points and 15 min （6.72±2.21） points after extubation in group A were higher than those in group B （7.54±2.21）points， （2.66±0.54） points and group C（6.95±2.12）points， （2.54±0.73） points， with statistically significant differences（P<0.05）. The Ramsay sedation score at 0 min after extubation in group B （3.61±0.53） points and group C （3.75±0.83） points were higher than that in group A （2.53±0.81） points， with statistically significant difference（P<0.05）. The incidence of oculocardiac reflex in group B was 80.00%， which was significantly higher than that in group A （56.67%） and C （60.00%）， with statistically significant difference（P<0.05）.The incidence of nausea and vomiting in group A was 66.67%， which was significantly higher than those in group B（33.33%） and group C（43.33%）， with statistically significant difference （P<0.05）. The number of dexmedetomidine remedies in group A was 18 cases， which was significantly higher than that in group B （n=3） and group C（n=0）， with statistically significant difference（P<0.05）. Conclusion The application of a single dose of dexmedetomidine at the end of eye muscle operation in pediatric strabismus surgery can reduce the incidence of postoperative agitation without increasing the incidence of oculocardiac reflexes.