目的 探讨右美托咪定联合氯胺酮对小儿扁桃体摘除术术前镇静的有效性及安全性。方法 选择2019-01至2020-12在解放军总医院第四医学中心麻醉科行扁桃体摘除术儿童90例,按照随机数字表法将患儿分为右美托咪定(dexmedetomidine,D)组、氯胺酮(ketamine,K)组和右美托咪定联合氯胺酮(dexmedetomidine and ketamine,D+K)组,每组30例。术前分别经鼻滴入右美托咪定、氯胺酮和右美托咪定联合氯胺酮,45 min后转入手术室麻醉并行扁桃体摘除术,比较3组患儿术前心率、平均动脉压、血氧饱和度、镇静状态评分及记录术后苏醒时间、拔管时间、疼痛评分、躁动评分、不良反应发生情况。结果 (1)镇静状态评分:D+K组镇静状态评分明显较低,镇静效果优于D组和K组,差异有统计学意义(P<0.05);(2)术后情况:D+K组患儿苏醒时间较短,术后躁动评分较低,差异有统计学意义(P<0.05);3组患儿术后不良反应发生情况无统计学意义,但D+K组不良反应数明显少于其他两组。结论 右美托咪定联合氯胺酮用于小儿扁桃体摘除术术前镇静效果,优于两者单独使用,并能减少苏醒期躁动。
Abstract
Objective To study the efficacy and safety of dexmedetomidine combined with ketamine before pediatric tonsillectomy. Methods Ninety children of ASA grade Ⅰ~Ⅱ, aged 2 to 6 and weighing 13-25 kg underwent tonsillectomy in our hospital between January 2019 to December 2020.These patients were randomly assigned to three groups with 30 cases in each. Before operation, dexmedetomidine, ketamine, and dexmedetomidine combined with ketamine were instilled respectively through the nose. After 45 minutes, they were transferred to the operating room for anesthesia and enucleation before they returned to their wards after operation. The preoperative heart rate, mean arterial pressure, blood oxygen saturation, sedation score, and postoperative recovery time, extubation time, pain score, agitation score, and adverse reactions were compared between the three groups. Results Hemodynamic results showed that the heart rate of the D+K group decreased significantly at the 45th minute, and the difference was statistically significant (P<0.05).The sedation status score of the D+K group was significantly lower, the sedation effect was better than that of the D and K groups, and the difference was statistically significant (P<0.05). A comparison of postoperative conditions showed that children in the D+K group had a shorter wake-up time and lower scores of postoperative restlessness, and the difference was statistically significant (P<0.05). Although the incidence of adverse reactions was not significantly different between the three groups, the number of adverse reactions in the D+K group was significantly smaller than in the other two groups. Conclusions The sedative effect of dexmedetomidine combined with ketamine before pediatric tonsillectomy is better than that of the two used alone, for restlessness can be effectively prevented during recovery. Therefore, it is a safe and efficient sedation method.
关键词
右美托咪定 /
氯胺酮 /
滴鼻 /
小儿 /
扁桃体摘除术 /
镇静效果
Key words
dexmedetomidine /
ketamine /
intranasal /
children /
tonsillectomy /
sedative effect
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参考文献
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