右美托咪定喷鼻在小儿无痛电子结肠镜检查术中的应用效果  

Clinical effect of intranasal dexmedetomidine as premedication on sedation and analgesia during painless electronic colonoscopy in children

作　　者：王建平[1] 孟凡民[1] 

机构地区：[1]河南省人民医院麻醉科,郑州450003

出　　处：《中华消化内镜杂志》2017年第2期112-117,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价右美托咪定喷鼻在小儿无痛电子结肠镜检查术中的应用效果，并探索其适宜剂量。方法择期行无痛电子结肠镜检查术的90例患儿，采用随机数字表法分成3组，每组30例，分别于检查前30min使用咪达唑仑0．2mg／kg（A组）、右美托咪定1．0μg/kg（B组）和右美托咪定2．0μg／kg（C组）喷鼻，均采用单纯丙泊酚麻醉方式，待患儿睫毛反射消失后即行结肠镜检查术。记录3组患儿喷鼻前10min（T0）、喷鼻后30min（T1）、睫毛反射消失时（T2）、检查开始即刻（T3）、镜身过脾曲时（T4）、镜身过肝曲时（T5）、术毕（T6）及完全清醒时（T7）的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）及脉搏血氧饱和度（SpO2）；喷鼻前10min以及喷鼻后10、20和30min时的脑电双频指数（BIS）及警觉与镇静评分（OAA／S评分）；患儿与家长分离时的镇静情绪评分及静脉穿刺接受程度评分；围术期不良反应的发生情况。以上观察项目先行3组间比较，发现差异（P〈0．05）后再行两两比较，以明确具体是哪两组间存在统计学差异（P〈0．017）。结果3组患儿术中血流动力学均较平稳。与A组和B组同时点比较，C组患儿喷鼻后10～30min的BIS及OAA／S评分均明显降低（P〈0．017）。C组患儿与家长分离时的镇静情绪评分及静脉穿刺接受程度评分均明显高于A组和B组（P〈0．017）。C组患儿麻醉苏醒时间和丙泊酚用量均明显短于或少于A组和B组（P〈0．017）。C组患儿术中高血压、窦性心动过速、体动反应等发生率及术后躁动不安发生率均明显低于A组和B组（P〈0．017）。B组和C组患儿喷鼻刺激发生率均明显低于A组（P〈0．017），C组患儿注射痛发生率均明显低于A组和B组（P〈0．017）。结论右美托咪定喷鼻可安全用于小儿无痛电子结肠镜检查术，可有效提高患儿的依从性，具有较好的�Objective To explore the clinical effect of intranasal dexmedetomidine as premedication on sedation and analgesia during painless electronic colonoscopy in children, and to investigate its optimal dose. Methods Ninety children scheduled for painless electronic colonoscopy were divided into three groups by using a computer-generated randomization schedule, 30 per group. Children were pretreated with 0. 2 mg/kg midazolam （group A）, 1.0 μg/kg dexmedetonfidine （group B） or 2. 0 μg/kg dexmedetomidine （group C） by nasal drip 30 rain before operation. The anesthesia protocol was programmed by propofol in the three groups. After eyelash reflex disappeared, the examination was performed. Mean artery blood pressure （MAP） , heart rate （HR）, respiratory rate （RR） and oxygen saturation （SpO2） of children were recorded at 10 min before intranasal administration （ T0 ）, 30 rain after intranasal administration （ T1 ）, at the onset of eyelash reflex disappearance （T2 ） and the onset of examination initiating（ T3 ）, at lens passing through splenic flexure （T4 ）, or through hepatic flexure （ T5 ）, at the end of examination （ T6 ） and when patients were fully awake （ T7 ）, respectively. Bispectral index （BIS） and the observer＇s assessment of alertness/sedation scale （OAA/S） were performed at 10 min before intranasal administration （T0）, 10 min, 20 min and 30 min after intranasal administration in the three groups. Mood score at parent-children separation and venipuncture acceptance score were also recorded. The adverse reactions during examination were analyzed. The above observed indices were compared among the three groups. If there was statistical difference （P 〈 0. 05 ）, pairwise comparison was performed （P〈0. 017）. Results The children＇s haemodynamics were all stable in the three groups. Compared with group A and group B at the same time point, BIS and OAA/S were all lower （P〈0. 017） in 10 to 30 min after intranasal administration in

关 键 词：咪达唑仑 右美托咪定 喷鼻 无痛电子结肠镜检查 小儿 

分 类 号：R726.1[医药卫生—儿科]