右美托咪定滴鼻对小儿扁桃体腺样体切除术苏醒期躁动及血流动力学的影响  

Application of Intranasal Dexmedetomidine Premedication on Pediatric Adenotonsillectomy Patients

作　　者：高龙飞[1] 高昌俊[1] 韩瑞丽[1] 孙绪德[1] 王彬荣[1] 郑琴[1] 李晶晶[1] GAO Long-fei GAO Chang-jun HAN Rui-li SUN Xu-de WANG Bin-rong ZHENG Qin LI Jing-jing(Department of Anesthesiology, the Second Affiliated Hospital of The Fourth Military Medical University, Xi＇an, Shaanxi, 710038, China)

机构地区：[1]第四军医大学唐都医院麻醉科,陕西西安710038

出　　处：《现代生物医学进展》2017年第20期3855-3859,共5页Progress in Modern Biomedicine

基　　金：陕西省卫生科研项目(D63)

摘　　要：目的:观察右美托咪定术前滴鼻对行扁桃体腺样体切除术患儿在围术期血流动力学和苏醒期躁动的影响。方法:择期行扁桃体腺样体切除术的患儿60例,随机分为右美托咪定组(D组)和生理盐水组(C组)。在麻醉诱导前30 min,D组患儿经鼻滴入右美托咪定,C组患儿经鼻滴入生理盐水。给药30 min后,进行静脉麻醉诱导。记录患儿的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_2),患儿滴鼻接受程度、手术时间、拔管时间以及并发症的发生情况;根据麻醉苏醒期躁动量化评分表(PEAD)和改良加拿大东安大略儿童医院疼痛评分量表(m-CHEOPS)对患儿进行评分并记录术后苏醒期躁动发生率。结果:与C组相比,D组各个时间点的MAP、HR有统计学差异(P<0.05),D组围术期生命体征变化相对平稳;两组患儿SpO_2、滴鼻接受程度、患儿手术时间比较均无统计学意义(P>0.05);两组患儿拔管时间比较有差异(P<0.05);D组患儿苏醒期PAED评分和m—CHEOPS评分均低于C组患儿(P<0.05);两组患儿在围术期均无恶心呕吐,喉痉挛等不良反应的发生。结论:右美托咪定滴鼻可安全、有效的用于小儿患者,并且可使围术期血流动力学平稳及减少苏醒期躁动的发生。Objective：To observe the effect of intranasal Dexmedetomidine on hemodynamic during perioperative period and postoperative agitationfor children,undergoing tonsillectomy and adenoidectomy.Methods：60 children undergoing tonsillectomy and adenoidectomy surgery were randomly divided into dexmedetomidine group （Group D） and physiological saline group （Group C）.30 min before the induction of anesthesia,children were received intranasal Dexmedetomidine in the group D,children were received physiological saline in the group C.30 min after administration,induction of anesthesia was performed quickly.The mean arterial pressure （MAP）,heart rate （HR）,blood oxygen saturation （SpO2）,the degree of nasal drip,operation time,extubation time and complications were recorded.According to the Pediatric Anesthesia Emergence Delirium and the modified Children＇s Hospital of Eastern Ontario Pain Scale the patient was marked.The occurrence rate of postoperative agitation wasrecorded.Results：Compared with group C,the MAP and HR of group D at each point were statistically different （P ＜0.05）.There was no significant difference on SpO2,the acceptability of nasal inhalation and surgical time between the two groups （P ＞0.05）.PAED score and m-CHEOPS scores of group D were significantly lower than Group C （P ＜0.05）.Conclusion：Intranasal dexmedetomidine can be used for children to stabilize hemodynamic change during perioperative period and to decrease the incidence rate of emergence delirium.

关 键 词：右美托咪定 滴鼻 小儿 术后躁动 血流动力学 

分 类 号：R614.2[医药卫生—麻醉学] R726[医药卫生—外科学]