右美托咪定经鼻黏膜给药装置鼻腔给药对小儿斜视患者术前焦虑和术后躁动的影响  

Study on the effect of nasal application of LMA MAD of dexmedetomidine on preoperative anxiety and emergent delirium after anesthesia in pediatric patients with strabismus surgery

作　　者：罗欣[1] 李小葵[2] 董鹏[1] 李天佐[2] 朱蕊[3] 

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,北京100050 [2]首都医科大学附属同仁医院麻醉科,北京100730 [3]首都医科大学附属北京复兴医院麻醉科,北京100038

出　　处：《临床和实验医学杂志》2016年第20期2052-2055,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的观察诱导前给予盐酸右美托咪定（DEX）经鼻黏膜给药装置鼻腔给药对斜视手术患儿七氟烷麻醉下术前焦虑和术后躁动的影响。方法 60例2~6岁、择期行斜视矫正术的小儿患者随机分为右美托咪定组和对照组,每组30例。右美托咪定组患者用生理盐水将DEX 2μg/kg配制成0.6 ml后使用鼻黏膜给药装置滴鼻,对照组患者单纯使用0.6 ml生理盐水经鼻黏膜给药装置滴鼻。经鼻给药后30 min,两组患者均进行诱导。另一名麻醉医生对小儿患者进行诱导并记录数据及各项指标[包括一般资料、镇静情绪评分、苏醒期躁动评分、诱导后即刻（T1）、手术开始时（T2）、手术开始后5 min（T3）、手术开始后15 min（T4）血流动力学数据、诱导后七氟烷浓度、诱导时间和苏醒时间]。对两组患者的临床资料进行比较。结果两组患儿年龄、体重、性别构成比、麻醉持续时间及手术时间组间比较差异无显著性（P〉0.05）。右美托咪定组患儿术前镇静满意程度明显高于对照组（P〈0.05）,诱导时间、苏醒期躁动评分明显低于对照组（P〈0.05）,诱导时间明显少于对照组（P〈0.05）;两组苏醒时间差异无统计学意义（P〉0.05）。两组患儿呼气末七氟烷浓度（ETsevo）在手术开始后随着时间的延长降低,右美托咪定组在T1~4时点ETsevo均小于对照组（P〈0.05）。右美托咪定组与对照组比较,收缩压（SBP）在T1~4时间点显著低于对照组（P〈0.05）;右美托咪定组心率（HR）在T1~4时间点显著低于对照组（P〈0.05）。结论诱导前应用鼻黏膜给药装置给予2μg/kg盐酸右美托咪定滴鼻可降低小儿术前焦虑水平,降低七氟烷麻醉术后苏醒期躁动发生的可能性,在缩短七氟烷麻醉诱导时间的同时不延长麻醉苏醒时间。Objective The aim of this study is to observe the effect of nasal application of LMA MAD of dexmedetomidine before operation on anxiety before operation and emergent delirium after sevoflurane induction in strabismus surgery. Methods Sixty 2 -6 years old patients scheduled to undergo strabismus surgery under sevoflurane were allocated into two groups （30 cases in each group） ： 6exmedetomidine group and control group. Patients in dexmedetomidine group received intranasal application of dexmeditomidine 2 μg/kg, and patients in control group received intranasal placebo （ normal saline） 0. 6 ml using LMA MAD for nasal aplication. All pediatric patients were seperated from their parents and induced into operating room for anesthesia induction. Anesthesiologists observed nothing about drug given and recorded the monitoring indicators [ including general data, the sedation scores, agitation scores, end - tidal sevoflurane concentration after induction, induction time, awakening time as well as the data of hemodynamics at the moment after induction （ T1 ）, the initiation of operation （ T2 ） and 5 rain （ 33 ） and 15 min （T4） l after starting of operation. Results The sedation scores before operation 〉 3 was higher in dexmedetomidine group than that of control group （ P 〈 0.05 ）. In control group, the induction time and agitation scores were obviously higher than those of dexmedetomidine group. The induction time in dexmedetomidine group was obviously cut down. The difference in eye - opening time between these two groups was not significant （ P 〉 0.05 ）. SBP and HR were lower in dexmedetomidine group than those of control group. The end -tidal sevoflurane concentration （ETsevo） was lower in dexmedetomidine group than that of control group at T1 - 4 （ at the end of anesthesia induction, the initiation of operation, 5 min and 15 min after the inflation of operation）. Conclusion The nasal application of LMA MAD of dexmeditomidiue 2 μg/kg before operation is effective for reli

关 键 词：小儿 斜视矫正手术 七氟烷麻醉 盐酸右美托咪定 经鼻黏膜给药装置 鼻腔给药 

分 类 号：R726.1[医药卫生—儿科]