摘要
目的评价右美托咪定不同时段给药对小儿开颅手术麻醉苏醒质量及炎症反应的影响。方法采用随机双盲法将2017年8月至2022年8月在北京丰台医院接受小儿开颅手术的200例患儿分为4组,每组各50例。术前组于麻醉诱导前30min静脉泵注0.5μg/(kg·h)右美托咪定,手术开始前停药;术中组于手术开始后静脉泵注0.5μg/(kg·h)右美托咪定,手术结束前30min停药;术后组于手术主要步骤结束后静脉泵注0.5μg/(kg·h)右美托咪定,术毕停药;对照组于麻醉诱导前30min静脉泵注同等容量的生理盐水,比较4组患儿的苏醒质量、血流动力学、炎症反应、不良反应。结果术后组拔管时间[(43.84±5.12)min]显著长于术前组[(16.73±3.28)min]、术中组[(18.05±3.47)min]和对照组[(25.63±4.64)min],差异具有统计学意义(P<0.05);术前组、术中组麻醉诱导前安静状态下(T_(0))、拔管即刻(T_(1))、拔管后5min(T_(2))Ramsay镇静评分、平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)及白细胞介素(interleukin,IL)-6比较,差异无统计学意义(P>0.05);术后组患儿T_(1)、T_(2)时点的Ramsay镇静评分及CRP、TNF-α、IL-6水平显著高于术前组、术中组和对照组,MAP、HR显著低于术前组、术中组和对照组,差异有统计学意义(P<0.05);4组患儿的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论于小儿开颅手术不同时间段静脉泵注右美托咪定均未见明显不良反应,但术前、术中静脉泵注右美托咪定对麻醉恢复期的血流动力学、炎症反应影响较小,苏醒质量及镇静质量较佳,术后静脉泵注延长拔管时间。
Objective To evaluate the effect of dexmedetomidine administered at different time points on the quality of anesthesia recovery and inflammatory response in children undergoing craniotomy.Methods According to the randomized double-blind method,200 pediatric patients who underwent craniotomy in Beijing Fengtai Hospital from August 2017 to August 2022 were divided into 4 groups,with 50 cases in each group.In preoperative group,0.5μg/(kg∙h)dexmedetomidine was intravenously pumped 30min before anesthesia induction,and the drug was stopped before the start of surgery.In intraoperative group,0.5μg/(kg∙h)dexmedetomidine was infused intravenously after the beginning of the operation,and the drug was stopped 30min before the end of the operation.In postoperative group,0.5μg/(kg∙h)dexmedetomidine was infused intravenously after the main steps of the operation,and the drug was discontinued at the end of the operation.In control group,the same volume of normal saline was injected intravenously 30min before anesthesia induction.The recovery quality,hemodynamics,inflammatory response,and adverse reactions were compared among the four groups.Results The extubation time of postoperative group[(43.84±5.12)min]was significantly longer than that of preoperative group[(16.73±3.28)min],intraoperative group[(18.05±3.47)min],and control group[(25.63±4.64)min],the difference was statistically significant(P<0.05).Ramsay sedation scores,mean arterial pressure(MAP),heart rate(HR),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin(IL)-6 were compared between preoperative group and intraoperative group before anesthesia induction in a quiet state(T_(0)),immediately after extubation(T_(1))and 5min after extubation(T_(2)).The difference was not statistically significant(P>0.05).Ramsay sedation scores and levels of CRP,TNF-αand IL-6 at T_(1) and T_(2) in postoperative group were significantly higher than those in preoperative group,intraoperative group and control group,and MAP and HR were significantly lower than those in preoperative group,intraoperative group and control group,with statistically significant differences(P<0.05).There was no significant difference in the overall incidence of adverse reactions among the four groups(P>0.05).Conclusion Intravenous infusion of dexmedetomidine at different time points in children undergoing craniotomy has no obvious adverse reactions,but intravenous infusion of dexmedetomidine before and during operation has little effect on hemodynamics and inflammatory response during anesthesia recovery period,and the quality of recovery and sedation is better.Intravenous infusion of dexmedetomidine after operation will prolong extubation time.
作者
杨迎春
吕红杰
史晓燕
刘晶晶
YANG Yingchun;LYU Hongjie;SHI Xiaoyan;LIU Jingjing(Department of Anesthesiology,Beijing Fengtai Hospital,Beijing 100071,China;Department of Anesthesiology,Beijing General Hospital of the Chinese People’s Armed Police Force,Beijing 100027,China)
出处
《中国现代医生》
2023年第36期106-111,共6页
China Modern Doctor
关键词
小儿开颅手术
不同时段给药
右美托咪定
麻醉苏醒质量
炎症反应
Craniotomy in children
Administration at different times
Dexmedetomidine
Anesthesia recovery quality
Inflammatory response
