目的 觀察右美托咪定對小兒腹腔鏡手術(shù)中順式阿曲庫銨肌松效應(yīng)的影響。方法 選擇2014年1月-2016年1月秦皇島市第一醫(yī)院行腹腔鏡手術(shù)患兒40例，隨機(jī)分為對照組和治療組，每組各20例。兩組術(shù)中靜脈輸注注射用苯磺順阿曲庫銨，誘導(dǎo)劑量0.1 mg/kg，維持劑量1~2 μg/（kg·min^-1）。治療組麻醉誘導(dǎo)前20 min滴鼻鹽酸右美托咪定注射液，3 μg/kg，持續(xù)15 min，插管后靜脈泵入鹽酸右美托咪定注射液，0.5 μg/（kg·h^-1），持續(xù)至手術(shù)結(jié)束前20 min；對照組用等量生理鹽水代替。觀察兩組肌松效應(yīng)指標(biāo)、血流動力學(xué)指標(biāo)、肌松恢復(fù)指標(biāo)和Steward評分情況。結(jié)果 治療組肌松起效時(shí)間明顯短于對照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。在誘導(dǎo)時(shí)刻、插管后3 min和拔管后30 min，治療組平均動脈壓（MAP）明顯低于誘導(dǎo)前20 min，比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；在誘導(dǎo)時(shí)刻、插管時(shí)刻、拔管時(shí)刻和拔管后30 min，治療組MAP明顯低于對照組同期，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。在插管時(shí)刻，對照組HR低于誘導(dǎo)前20 min，在拔管后30 min，對照組心率（HR）高于誘導(dǎo)前20 min，比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；在誘導(dǎo)時(shí)刻、插管時(shí)刻和拔管后30min，治療組HR低于誘導(dǎo)前20 min，比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；在誘導(dǎo)時(shí)刻、插管時(shí)刻、插管后3 min和拔管后30 min，治療組HR明顯低于對照組同期，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療組肌松起效時(shí)間明顯短于對照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05），而兩組肌松維持時(shí)間比較差異無統(tǒng)計(jì)學(xué)意義。兩組肌松恢復(fù)指標(biāo)和Steward評分比較差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 右美托咪定可以增強(qiáng)小兒腹腔鏡手術(shù)中順式阿曲庫銨的肌松效應(yīng)，但不會延長維持時(shí)間及其術(shù)后在體內(nèi)消除時(shí)間，安全性較好，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To observe the effect of dexmedetomidine on muscle relaxation of cisatracurium in pediatric laparoscopic surgery. Methods Children (40 cases) with laparoscopic surgery in First Hospital of Qinhuangdao from January 2014 to January 2016 were randomly divided into control and treatment groups, and each group had 20 cases. Children in two groups were iv administered with Cisatracurium Besilate for injection during surgery, induced dosage of 0.1 mg/kg, maintain dosage of 1 - 2 μg/(kg·min^-1). At 20 min before anesthesia induction, children in the treatment group were nasal drip administered with Dexmedetomidine Hydrochloride Injection, 3 μg/kg, maintained for 15 min, and usage for change were iv pump, 0.5 μg/(kg·h^-1), maintained for 20 min. But children in the control group were replaced with normal saline equivalent. Muscle relaxation indexes, hemodynamics indexes, muscle relaxation recovery indexes, and Steward score in two groups were compared. Results Onset time of muscle relaxation in the treatment group was significantly shorter than that in the control group, and there was difference between two groups (P < 0.05). At the anesthesia induction time, 3 min after intubation, and 30 min after extubation, the MAP in the treatment group were lower than that in treatment group at 20 min before anesthesia induction, and there was statistically significant in the same group (P < 0.05). At anesthesia induction time, intubation time, extubation time, and 30 min after extubation, the MAP in the treatment group were lower than those in control group in the same period. At intubation time, the HR in the control group was lower than that in the control group at 20 min before anesthesia induction, but the HR in the control group was higher than that in the control group at 30 min after extubation, and there was statistically significant in the same group (P < 0.05). At anesthesia induction time, intubation time, and 30 min after extubation, the HR were lower than that in the treatment group at 20 min before anesthesia induction, and there was statistically significant in the same group (P < 0.05). At anesthesia induction time, intubation time, 3 min after intubation, and 30 min after extubation, the HR in the treatment was lower than that in the treatment group at 20 min before anesthesia induction, and there was statistically significant in the same group (P < 0.05). The onset time of muscle relaxation in the treatment group was significantly shorter than that in the control group, and there was statistically significant in the same group (P < 0.05), but there was no significant difference in the duration of muscle relaxation between two groups. There was no significant difference in the recovery index of muscle tone and Steward score between two groups. Conclusion Dexmedetomidine can enhance muscle relaxation effect of cisatracurium in pediatric laparoscopic surgery, but it does not prolong the maintenance time, and the time of elimination in vivo, with good safety, which has a certain clinical application value.

秦皇島市科技支撐計(jì)劃項(xiàng)目（201602A125）