目的 观察右美托咪定对小儿腹腔镜手术中顺式阿曲库铵肌松效应的影响。方法 选择2014年1月-2016年1月秦皇岛市第一医院行腹腔镜手术患儿40例，随机分为对照组和治疗组，每组各20例。两组术中静脉输注注射用苯磺顺阿曲库铵，诱导剂量0.1 mg/kg，维持剂量1~2 μg/（kg·min^-1）。治疗组麻醉诱导前20 min滴鼻盐酸右美托咪定注射液，3 μg/kg，持续15 min，插管后静脉泵入盐酸右美托咪定注射液，0.5 μg/（kg·h^-1），持续至手术结束前20 min；对照组用等量生理盐水代替。观察两组肌松效应指标、血流动力学指标、肌松恢复指标和Steward评分情况。结果 治疗组肌松起效时间明显短于对照组，两组比较差异具有统计学意义（P<0.05）。在诱导时刻、插管后3 min和拔管后30 min，治疗组平均动脉压（MAP）明显低于诱导前20 min，比较差异有统计学意义（P<0.05）；在诱导时刻、插管时刻、拔管时刻和拔管后30 min，治疗组MAP明显低于对照组同期，两组比较差异有统计学意义（P<0.05）。在插管时刻，对照组HR低于诱导前20 min，在拔管后30 min，对照组心率（HR）高于诱导前20 min，比较差异有统计学意义（P<0.05）；在诱导时刻、插管时刻和拔管后30min，治疗组HR低于诱导前20 min，比较差异有统计学意义（P<0.05）；在诱导时刻、插管时刻、插管后3 min和拔管后30 min，治疗组HR明显低于对照组同期，两组比较差异有统计学意义（P<0.05）。治疗组肌松起效时间明显短于对照组，两组比较差异具有统计学意义（P<0.05），而两组肌松维持时间比较差异无统计学意义。两组肌松恢复指标和Steward评分比较差异无统计学意义。结论 右美托咪定可以增强小儿腹腔镜手术中顺式阿曲库铵的肌松效应，但不会延长维持时间及其术后在体内消除时间，安全性较好，具有一定的临床推广应用价值。

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.

秦皇岛市科技支撑计划项目（201602A125）