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术中使用右旋美托咪定或吗啡对儿童扁桃体腺样体切除术术后镇痛的影响
A comparison of intra-operative dexmedetomidine versus morphine for the effect on emergence pain after adenotonsillectomy in Children

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DOI:
作者:
庄培钧
Zhuang peijun
作者单位:
复旦大学附属儿科医院
Department of Anesthesiology,Children’s Hospital of Fudan University,shanghai
关键词:
右旋美托咪定；扁桃体腺样体切除术；呼吸抑制
dexmedetomidine; adenotonsillectomy; respiratory depression
摘要:
【摘要】　目的　本研究以随机、对照和双盲的设计评价术中使用右旋美托咪定或吗啡对儿童扁桃体腺样体切除术术后镇痛的影响，从而了解右旋美托咪定能否在此类手术中替代吗啡。 方法　选择因睡眠呼吸暂停综合征而拟行扁桃体腺样体切除术的儿童60例(ASA Ⅰ～ Ⅱ级) ,2-13岁，术前口服对乙酰氨基酚15mg/kg，将其随机分为两组:D 组( n = 30) :诱导时给予右旋美托咪定1μg/ kg；M 组(n= 30) :诱导时给予吗啡100μg/ kg 。术中记录心率、无创血压和氧饱和度，术后1小时内每间隔15分钟评估患儿呼末CO2、CHEOPS评分、Ramsey评分、补救吗啡用量和时间、心率、无创血压和氧饱和度。结果　呼末CO2 D组比M组低（p<0.01）；CHEOPS疼痛评分D组略高于M组（p＝0.023）；术后D组中更多患者需要吗啡补救镇痛 (p=0.037)，但术后补救吗啡的用量两组相似(p=0.267)； Ramsey镇静评分两组相似（p＝0.099）。 结论　右旋美托咪定对儿童扁桃体腺样体切除术术后的呼吸抑制作用比吗啡弱，且能提供类似的术后镇痛作用，可以在儿童扁桃体腺样体切除术中作为一个可供临床选择的麻醉药物。
【Abstract】 Objective To compare intra-operative dexmedetomidine with morphine for the effect on emergence pain after adenotonsillectomy in children using a randomized、double-blind and control design. To know that if dexmedetomidine can substitute morphine in these operations. Methods Sixty children after adenotonsillectomy because of obstructive sleep apnea syndrome, two to thirteen years of age and ASA physical status I or II, were randomly divided into two groups with 30 cases each. Children in Group D received dexmedetomidine 1 mcg/kg over 10mins in induction. Children in Group M received morphine 0.1 mg/kg in induction. All children received oral paracetamol 15 mg/kg half an hour preoperatively. CO2ET、CHEOPS SCORES、Ramsey Scores、rescure morphine、Heart rate、Blood pressure and Saturationare are recorded .Intra-operative Heart Rate、Blood Pressure and Saturation are also recorded. Results The CO2ET was lower in Group D than in Group M(p<0.01).The CHEOPS score was a little higher in Group D than that in Group M(p=0.023). More patients need rescure morphine in Group D than in Group M(p=0.037),But the amount is similar between the two groups(p=0.267). The Ramsey score was similar between groups (p=0.099). Conclusion Dexmedetomidine can provide moderate analgesia for children after adenotonsillectomy, similar with morphine, but with less respiratory depression. Dexmedetomidine is a novel drug which can be used in adenotonsilllectomy in children.

 

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