摘要：
Objective To observe the efficacy of intranasal dexmedetomidine Dex) premedication in paediatric patients undergoing strabismus surgery under ketamine (Ket) anaesthesia.Methods Sixty children underwent elective strabismus surgery,aged 3-6 years,weighed 10-25 kg,were randomly divided into two groups.Dex combined with Ket anaesthesia as group DK and Ket anaesthesia as group K,each group contained 30 cases.30 min before entering the operating theater,in group DK,Dex was given intranasally with a dose of 2 μg/kg,while patients in group K received the same amounts of saline.Ket was used in both groups for anesthesia induction.Heart rate (HR) and oxygen saturation (SpO2) were recorded at 5 time points:before administration of Dex (T0),10 (T1),20 (T2),30 (T3) min after administration of Dex and after administration of Ket (T4).The number of extraocular muscles that were resected and the minimal heart rate during this procedure were recorded.The oculocardiac reflex (OCR),emergence agitation (EA) and other related complications were statisticsed.The dosage of Ket and the awakening time were also included in the record.Results At T0-T3,there were no significant difference in HR or SpO2 between two groups (P ＞ 0.05).Compared with T3,the HR at T4 in both groups was significantly increased.But compared to group K,the HR in group DK was significantly decreased (P ＜0.05).The incidence of OCR and vomiting,the pediatric anesthesia emergence delirium scale in group DK were significantly lower than that in group K (P ＜ 0.05).The dosage of Ket was significantly lower in group DK (P ＜ 0.05).There was no significant difference in awakening time between two groups (P ＞ 0.05).Conclusion Intranasal dexmedetomidine in a preoperative dose of 2 μg/kg could decrease the adverse reactions and the dosage of Ket during paediatric strabismus surgery.%目的 观察右美托咪定滴鼻预处理在小儿斜视手术氯胺酮麻醉中应用的效果.方法 斜视矫正手术60例,年龄3～6岁,体质量10～25 kg,随机分为右美托咪定联合氯胺酮麻醉组(DK组)和氯胺酮麻醉组(K组).入手术室前30 min,DK组经鼻滴入右美托咪定2μg/kg,K组以等量的生理盐水滴鼻,两组均使用氯胺酮麻醉诱导.记录两组患儿滴鼻前(T0)、滴鼻后10 min(T1)、20min(T2)、30 min(T3)及氯胺酮诱导后(T4)的心率和血氧饱和度;记录术中切除眼肌数目及切除眼肌时的最低心率,统计眼心反射、苏醒期躁动及其他相关并发症发生的情况;记录氯胺酮的用量及术毕苏醒时间.结果 T0～ T3时,两组患儿的心率及血氧饱和度差异无统计学意义(P＞0.05).与T3时比较,T4时两组的心率明显上升,但DK组的心率明显慢于K组(P＜0.05).眼心反射和呕吐的发生率及苏醒期躁动评分,DK组明显低于K组(P＜0.05).DK组氯胺酮的用量明显少于K组(P＜0.05),两组苏醒时间差异无统计学意义(P＞0.05).结论 2μg/kg右美托咪定滴鼻预处理可减少小儿斜视手术中不良反应的发生并可减少氯胺酮的用量.
