中文摘要：

目的探讨右美托咪定在小儿扁桃体和腺样体切除术中的安全性及有效性。方法选取扁桃体和腺样体切除术患儿80例,采用随机数字表法分为对照组和观察组。2组患儿采用相同的基础麻醉方式,同时监测平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO_2）及呼气末二氧化碳分压（PetCO_2）。麻醉维持采用丙泊酚、瑞芬太尼,间断推注顺式阿曲库铵。观察组在基础麻醉上加用右美托咪定（DEX）。观察并记录2组患儿的基础值（T0）、插管即刻（T1）、上开口器（T2）、拔管即刻（T3）、拔管后3min（T4）的MAP、HR及苏醒期呕吐、嗜睡、疼痛的发生率。采用东安大略儿童医院疼痛评分（CHEOPS）评价患儿疼痛情况、Ramsay镇静评分评价患儿镇静水平。术后记录呼吸恢复时间、拔管时间及麻醉药用量。结果 MAP：观察组T1~T4各时间点均显著低于对照组,HR：T1、T3时点观察组相比对照组低,其差异有统计学意义（P〈0.05）。在呼吸恢复时间、拔管时间、疼痛评分、镇静评分方面,观察组均显著优于对照组;术中麻醉药物用量,对照组高于观察组（P〈0.05）。术后谵妄、躁动发生率观察组优于对照组（P〈0.05）。结论 DEX应用于小儿扁桃体和腺样体切除术,可减少对患儿血流动力学的影响,减少麻醉药物用量,术后谵妄、躁动发生率降低,延长术后拔管时间。

英文摘要：

Objective To investigate the safety and effect of dexmedetomidine on pediatric tonsillectomy and adenoidectomy surgery.Methods Eighty pediatric patients with tonsillectomy and adenoidectomy were randomly divided into control group and observation group.Both groups were given basic anesthesia with mean arterial pressure（MAP）heart rate（HR）,SpO_2 and PetCO_2 monitored.Anesthesia was maintained with propofol and remifentanil and intermittent bolus cisatracurium.Observation group was pumped dexmedetomidine（DEX）based on basic anesthesia.We observed and recorded the basis of the value of two groups of children（T0）,intubation（T1）,the instant of installing the mouth gag（T2）,extubation（T3）,3min after extubation（T4）,HR,MAP.The side effects such as vomiting,the incidence of drowsiness,pain,the score of CHEOPS evaluating the pain were observed.Ramsay sedation score was evaluated by the level of sedation.Breathing recovery time,extubation time and the amount of anesthetic were recorded.Results MAP at each time point（T1-T4）of the observation group were significantly lower than those of the control group.Compared to the control group,HR of the observation group was lower at T1 and T3,the difference was statistically significant（P〈0.05）.For breathing recovery time,extubation time,pain score,sedation score,the observation group were significantly better than the control group.For the amount of anesthetic drugs,the control group was higher than that in the observation group（P〈0.05）.Postoperative delirium,agitation rate in the observation group were significantly improved than those in the control group（P〈0.05）.Conclusion Dexmedetomidine applied to pediatric tonsillectomy and adenoidectomy can reduce the impact on hemodynamics in children,reduce the amount of narcotic,postoperative delirium and dysphoria,and delay extubation.