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目的探讨脑瘫患儿在选择性腰骶部脊神经后根切断术中不同剂量右美托咪定的使用效果及肌电图检测结果。方法选取2015年2月至2016年3月我院行选择性腰骶部脊神经后根切断术治疗的脑瘫患儿60例,根据随机数字表法分为A组与B组各30例。两组患儿均给予电生理监护仪监护,其中A组右美托咪定静脉输注的剂量为0.5μg/(kg·min),B组右美托咪定静脉输注的剂量为1.0μg/(kg·min)。分别比较两组手术时间、麻醉时间、清醒时间,用药前后患儿患儿神经根诱发肌电图(evoked electromyogram,EEMG)的潜伏期以及振幅保留率,平均动脉压、心率、血氧饱和度以及不良反应。结果两组患儿手术时间、麻醉时间、清醒时间比较差异均无统计学意义(P>0.05)。用药前后A组EEMG潜伏期以及振幅保留率与B组相比,差异均无统计学意义(P>0.05)。用药后B组平均动脉压以及心率分别为(60.5±5.1)mm Hg、(72.3±10.1)次/min,均显著低于A组的(63.8±6.6)mm Hg、(80.6±12.5)次/min。用药后两组不良反应发生率比较差异无统计学意义(P>0.05)。结论在选择性腰骶部脊神经后根切断术中给予脑瘫患儿0.5μg/(kg·min)剂量的右美托咪定具有更好的安全性。
Objective To investigate the use of dexmedetomidine in patients with cerebral palsy under selective posterior rhizotomy of the lumbosacral spinal nerve and the results of electromyography. Methods Sixty children with cerebral palsy who underwent selective posterior rhizotomy of the lumbosacral spinal nerve in our hospital from February 2015 to March 2016 were randomly divided into group A and group B, 30 cases in each group. Patients in both groups were given electrophysiological monitor care, in which the dose of intravenous infusion of dexmedetomidine was 0.5 μg / (kg · min) in group A, and the dose of dexmedetomidine intravenous infusion in group B was 1.0 μg / (kg · min). The time of operation, anesthesia time, awake time, latent period of evoked electromyogram (EEMG), amplitude retention rate, mean arterial pressure, heart rate, oxygen saturation and bad reaction. Results There was no significant difference in operative time, anesthesia time and awake time between the two groups (P> 0.05). Before and after treatment, the latency of EEMG and amplitude retention in group A were not significantly different from those in group B (P> 0.05). The mean arterial pressure and heart rate in group B after treatment were (60.5 ± 5.1) mm Hg and (72.3 ± 10.1) / min, respectively, which were significantly lower than those in group A (63.8 ± 6.6 mm Hg and 80.6 ± 12.5) min. There was no significant difference in the incidence of adverse reactions between the two groups after treatment (P> 0.05). Conclusion The dexmedetomidine given at a dose of 0.5 μg / (kg · min) in children with cerebral palsy has better safety in selective posterior rhizotomy of the lumbosacral spinal nerve.