不同剂量的右旋美托咪啶在不同年龄患儿滴鼻镇静效果的比较  

Sedative effects of different doses of intranasal dexmedetomidine in different age groups of children

作　　者：邱永升[1] 徐庆[2] 

机构地区：[1]郑州市儿童医院麻醉科,郑州450053 [2]中国医学科学院(北京协和医院)麻醉科,北京100730

出　　处：《医学研究生学报》2014年第4期394-397,共4页Journal of Medical Postgraduates

基　　金：河南省科技发展计划项目(122300410407)

摘　　要：目的：经鼻滴入右旋美托咪啶可使患儿达到镇静状态。文中旨在比较经鼻滴入不同剂量的右旋美托咪啶在不同年龄患儿的镇静效果。方法择期行单侧腹股沟疝气手术的患儿90例，年龄1～8岁，其中1～4岁52例，5～8岁38例， ASAⅠ-Ⅱ级，分为3组：右旋美托咪啶1μg/kg组、右旋美托咪啶2μg/kg组和对照组，每组30例。所有患儿术前35 min监测心率、平均动脉压（mean artery pressure， MAP）。右旋美托咪啶1μg/kg组经鼻滴入右旋美托咪啶1μg/kg；右旋美托咪啶2μg/kg滴入右旋美托咪啶2μg/kg；对照组滴入等渗盐水0．4 mL；30 min后采用七氟烷吸入诱导，建立静脉通路，静注舒芬太尼0．2μg/kg，放入喉罩，术中七氟烷维持麻醉，术毕恢复室观察2 h。记录用药前、用药后10 min、用药后20 min、用药后30 min、术毕时、清醒时的心率、MAP、RR、SpO2，应用Ramsay评分评估镇静满意度，记录镇静起效时间、术毕苏醒时间。结果在1～4岁年龄段，右旋美托咪啶1μg/kg组、右旋美托咪啶2μg/kg组的镇静满意率、镇静起效时间及苏醒时间差异无统计学意义（ P＞0．05）；右旋美托咪啶1μg/kg组、右旋美托咪啶2μg/kg组的镇静满意率（52％、53％）明显高于对照组（9％），差异有统计学意义（ P＜0．05）。在5～8岁年龄段，右旋美托咪啶2μg/kg组的镇静满意率（77％）明显高于右旋美托咪啶1μg/kg组（45％）和对照组（22％），右旋美托咪啶1μg/kg组的镇静满意率（45％）明显高于对照组（22％），差异有统计学意义（P＜0．05）。3组患儿围术期的MAP、心率和SpO2差异均无统计学意义（P＞0．05）。结论1～4岁的患儿术前经鼻滴入1μg/kg或2μg/kg的右旋美托咪啶产生镇静的效果接近，5～8岁的患儿经鼻滴入2μg/kg的该药可达到更高的镇静满意率。Objective Intranasal drops of dexmedetomidine can induce conscious sedation in children .This study was to com-pare the sedative effects of different doses of intranasal dexmedetomidine in different age groups of children patients . Methods We e-qually randomized 90 hernia children waiting for elective unilateral inguinal surgery （ ASAⅠ-Ⅱ） to groupsⅠ,ⅡandⅢ.At 35 minutes be-fore surgery, we obtained the heart rate （HR）, mean artery pressure （MAP） of all the patients.The children in groupsⅠandⅡreceived nasal instillation of dexmedetomidine at 1 and 2μg/kg respectively, while those in groupⅢ0.4 mL of normal saline, followed by sevoflu-rane induction, intravenous injection of sufentanil （0.2μg/kg）, and laryngeal mask airway anesthesia with sevoflurane .We recorded HR, MAP before medication, at 10 min, 20 min and 30 min before mediation, right after surgery, and at the recovery to consciousness . We also recorded the sedation onset time and post-surgery recovery time and assessed sedation satisfaction using the Ramsay score . Results The rates of satisfactory preoperative sedation were 50 and 63% in groupsⅠandⅡ, significantly higher than 10%in groupⅢ（P＆lt;0.05）. In the 1-4-year group, the sedation satisfaction rate , sedation onset 〈br〉 time and post-surgery recovery time showed no significant differences between groupsⅠandⅡ（P＆gt;0.05）.In the 5-8-year group, seda-tion satisfaction rate was markedly higher in groupⅡthan in groupsⅢ（77%vs 22%, P＆lt;0.05） andⅠ（77%vs 45%） . Conclusion At 1 and 2μg/kg, intranasal drops of dexmedetomidine produces similar rates of satisfactory sedation in children aged 1-4 years, and at 2μg/kg can achieve an even higher rate of satisfactory sedation without adverse hemodynamic effects in those aged 5-8 years.

关 键 词：右旋美托咪啶 滴鼻 儿童 

分 类 号：R971.2[医药卫生—药品]