摘要：

目的： 探究右美托咪定联合帕瑞昔布对小儿多生牙拔除术七氟醚麻醉后苏醒期躁动的影响。方法： 选取2019年8月—2022年8月于本院接受多生牙拔除术的患儿80例，随机数表法将患者分为2组。联合组40例：于麻醉诱导前10 min静脉泵注0.5 μg/kg右美托咪定+0.75 mg/kg帕瑞昔布，麻醉诱导后以0.4 μg/ （kg·h）持续泵注右美托咪定至手术完毕前5 min；对照组40例：以同等剂量生理盐水替换帕瑞昔布，以相同方案泵注0.5 μg/kg右美托咪定+生理盐水。2组均予以2%~4%七氟醚麻醉维持，术毕即刻停止使用七氟醚。比较2组入室时（T0）、预设药物输注10 min后（T1）、插管时（T2）、入恢复室时（T3）和患儿苏醒时（T4）患儿的心率（heart rate，HR）、平均动脉压（mean arterial pressure，MAP）和脉搏血氧饱和度（pulse oxygen saturation，SpO₂）；记录2组自主呼吸恢复时间、拔管时间、出麻醉恢复室时间、苏醒期间躁动与镇静情况及不良反应发生率。结果：2组HR和MAP的时间点、组间、时间点与组间交互差异有统计学意义（P<0.05）；T1—T4时，联合组HR、MAP水平均低于对照组（P<0.01）。联合组自主呼吸恢复时间、出麻醉恢复室时间均短于对照组（P<0.05）。联合组小儿苏醒期谵妄（pediatric anaesthesia emergence delirium，PAED）量表评分、苏醒期躁动发生率均低于对照组，Ramsay镇静评分高于对照组（P<0.05）。2组均出现恶心、呕吐、呛咳等不良反应，不良反应总发生率比较，差异无统计学意义（P>0.05）。结论：右美托咪定联合帕瑞昔布应用于七氟醚麻醉下小儿多生牙拔除术的方法，有利于维持患儿围手术期血流动力学的稳定、缩短麻醉后恢复时间、抑制苏醒期躁动，且不会增加不良反应。

关键词: 小儿多生牙拔除术, 麻醉, 右美托咪定, 帕瑞昔布, 苏醒期, 躁动

Abstract:

Objective: To investigate the influence of dexmedetomidine combined with parecoxib on emergence agitation in children after extraction of supernumerary teeth under sevoflurane anesthesia.Methods: A total of 80 children who underwent extraction of supernumerary teeth in the hospital from August 2019 to August 2022 were selected as the research subjects. According to the random number table method, the subjects were divided into combination group and control group. A total of 40 children (combination group) received intravenous injection of dexmedetomidine (0.5 μg/kg) and parecoxib (0.75 mg/kg) at 10 min before anesthesia induction, continuous injection of dexmedetomidine [0.4 μg/(kg·h)] after anesthesia induction till 5 min before the end of surgery, and the other 40 children (control group) received injection of the same dose of normal saline, and injection of dexmedetomidine (0.5 μg/kg) combined with normal saline in the same way. Both groups were mantained under anesthesia with 2% to 4% sevoflurane, and sevoflurane was immediately discontinued upon completion of the surgery. Heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO₂) at the time of entering the room (T0), 10 min after prespecified drug infusion (T1), intubation (T2), entering the recovery room (T3), and recovery (T4) were compared between the groups. The recovery time of spontaneous breathing, extubation time, time to leaving recovery room, agitation and sedation during recovery period, and the incidence of adverse reactions were recorded.Results: There were statistically significant differences in HR and MAP in terms of time effect, inter-group effect, and interaction effect (P<0.05). From T1—T4, the combination group had lower HR and MAP than the control group (P<0.01). The recovery time of spontaneous breathing and time to leaving recovery room in the combination group were shorter than those in the control group (P<0.05). The pediatric anaesthesia emergence delirium (PAED) scores and the incidence of emergence agitation in the combination group were lower than those in the control group, and the Ramsay sedation scores were higher than those in the control group (P<0.05). The total incidence of adverse reactions showed no significant difference between the groups (P>0.05).Conclusion: Dexmedetomidine combined with parecoxib in pediatric supernumerary teeth extraction under sevoflurane anesthesia is beneficial to maintain perioperative hemodynamic stability, shorten recovery time from anesthesia, and inhibit emergence agitation, without increasing adverse reactions.

Key words: extraction of pediatric supernumerary teeth, anesthesia, dexmedetomidine, parecoxib, recovery period, agitation

中图分类号: 

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• R782