右美托咪定复合静脉全身麻醉在小儿纤支镜检查治疗中的应用

Application of dexmedetomidine combined with intravenous general anesthesia in pediatric fiberoptic bronchoscopy

摘要:

目的：观察右美托咪定复合静脉全身麻醉用于小儿纤支镜检查的临床效果。方法：选择拟行纤支镜检查术的1~3岁患儿80例，美国麻醉医师协会分级（American Society of Anesthesiologists，ASA）分级Ⅰ～Ⅱ级，随机分为2组（n=40）：生理盐水组（NS组）和右美托咪定组（Dex组）。所有患儿检查前均雾化吸入2%盐酸利多卡因，Dex组于麻醉诱导前10 min静脉给予1 μg/kg负荷剂量的右美托咪定，NS组给予同等剂量的生理盐水。所有患儿均采用静脉复合全身麻醉，保留自主呼吸鼻咽通气道给氧。分别记录麻醉后纤支镜进入前（T1）、进镜至咽部 （T2）、进入声门（T3）、抵达隆突（T4）及第10分钟（T5）时的心率（heart rate，HR）、呼吸频率（respiration rate，RR）和无创平均动脉血压（mean artery blood pressure，MAP）、动脉血氧饱和度 （blood oxygen saturation，SpO2）。观察纤支镜检查期间有无呛咳、体动、声门痉挛、气道痉挛、严重缺氧、心肺复苏等不良事件的发生；记录患儿检查时间及苏醒时间，追加全身麻醉药的次数和剂量，离开手术室时小儿麻醉苏醒期躁动评分（pediatric anesthesia emergence delirium scale，PAED）及患者满意度。结果：2组患儿一般情况无统计学差异（P>0.05）。与T1比较，NS组T2、T3、T4及 T5的MAP和T2、T3、T4的HR明显升高，Dex组在T4时MAP明显升高（P<0.05）。与NS组比较，Dex组T2、T3、T4及 T5的MAP和T2、T3、T4的HR均明显降低（P<0.05）；使用丙泊酚和舒芬太尼的剂量以及追加次数明显减少，不良事件发生率降低，检查时间和苏醒时间明显缩短（P<0.05）；离室时PAED评分明显降低（P<0.05）；2组患者满意度无统计学差异（P>0.05）。结论：右美托咪定可安全用于静脉全身麻醉在婴幼儿纤支镜检查治疗且效果良好，获得更稳定的生命体征，减少全身麻醉药的用量，并降低术中不良事件的和术后躁动的发生率，缩短检查和苏醒时间。

Abstract:

Objective：To investigate the clinical effect of dexmedetomidine combined with intravenous general anesthesia in pediatric fiberoptic bronchoscopy. Methods：A total of 80 children aged 1-3 years who planned to undergo fiberoptic bronchoscopy and had an American Society of Anesthesiologists（ASA） grade of Ⅰ-Ⅱ were enrolled and randomly divided into normal saline group（NS group） and dexmedetomidine group（Dex group），with 40 children in each group. All children were given the inhalation of 2% lidocaine hy－drochloride before examination；the children in the Dex group were given dexmedetomidine with a loading dose of 1 μg/kg at 10 min－utes before induction of anesthesia，and those in the NS group were given the same dose of normal saline. All children were given in－travenous general anesthesia，and spontaneous breathing was reserved for nasopharyngeal oxygen therapy. Heart rate（HR），respiration rate（RR），noninvasive mean arterial blood pressure（MAP），and pulse oxygen saturation（SpO2） were recorded before the entrance of bronchoscope（T1），at the time when the bronchoscope reached the pharynx（T2），the glottis（T3），and the carina（T4），and at 10 minutes of the examination（T5）. Related adverse events were observed during fiberoptic bronchoscopy，such as bucking，body movement，glottic spasm，airway spasm，severe hypoxia，and car－diopulmonary resuscitation. The time of examination，awakening time，times and dosage of additional administration of general anesthetics，pediatric anesthesia emergence delirium scale（PAED） score at the time of discharge from operating room，and degree of satisfaction. Results：There were no significant differences in general con－ditions between the two groups（P>0.05）. The NS group had a significant increase in MAP at T2，T3，T4，and T5 and a significant in－crease in HR at T2，T3，and T4，while the Dex group had a significant increase in MAP at T4（P<0.05）. Compared with the NS group，the Dex group had significant reductions in MAP at T2，T3，T4，and T5 and HR at T2，T3，and T4（P<0.05），significantly lower times and dosage of additional administration of general anesthetics and incidence rates of adverse events，and significantly shorter time of examination and awakening time（P<0.05），as well as a significantly lower PAED score at the time of discharge from operating room（P<0.05）. There was no significant difference in degree of satisfaction between the two groups（P>0.05）. Conclusion：Dexmedetomidine is safe and effective in intravenous general anesthesia for infants and children during fiberoptic bronchoscopy. It can stabilize vital signs，reduce the dosage of general anesthetics and the incidence rates of intraoperative adverse events and postoperative agitation，and shorten the time of examination and awakening time