右美托咪定联合氯胺酮滴鼻用于小儿术前镇静的效果评估  

Effect of intranasal dexmedetomidine combined with ketamine on preoperative sedation in children

作　　者：刘剑霞[1] 杜敏[1] 刘巍[1] 徐颖[1] 

机构地区：[1]重庆医科大学附属儿童医院麻醉科儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室,重庆400014

出　　处：《重庆医科大学学报》2017年第12期1671-1675,共5页Journal of Chongqing Medical University

摘　　要：目的:观察右美托咪定联合氯胺酮滴鼻用于小儿术前镇静的效果及安全性。方法:选择于我院2016年3至6月拟行腭咽成形术、扁桃体摘除术,美国麻醉师协会(American Society of Anesthesiologists,ASA)I~Ⅱ级,年龄2~6岁的患儿155例,随机分为4组:D1组(n=37)和D2组(n=40)分别接受右美托咪定1μg/kg或2μg/kg滴鼻;D1+K组(n=38)及D2+K(n=40)组均接受1μg/kg或2μg/kg右美托咪定滴鼻,同时另一鼻孔行1 mg/kg氯胺酮滴鼻,40 min后转送入手术室,接受全身麻醉,术毕送入复苏室。滴鼻后每15 min记录患儿的心率(heart rate,HR)、平均动脉血压(mean arterial pressure,MAP)及血氧饱和度(oxygen saturation,SpO_2),记录准备转运到手术室时(T1)及麻醉诱导时(T2)改良镇静评分(modified observer's assessment of alertness/sedation score,m OAAS),记录镇静起效时间、手术时间、麻醉时间、苏醒时间、苏醒期躁动评分(pediatric anesthesia emergence delirium scale,PAED)、术后疼痛评分(face,legs,activity,crying,consolability scale,FLACC)及不良事件发生情况等。结果:4组患儿一般情况及麻醉时间、手术时间均无差异;D2+K组与其余3组(D1、D2、D1+K)比较镇静起效时间显著缩短(P<0.05);T1及T2时间点D2+K组与其余3组(D1、D2、D1+K)比较镇静成功率明显升高(P<0.01);D2组心动过缓发生率较其余3组显著升高(P<0.05),4组患儿苏醒时间、苏醒期躁动评分、术后疼痛评分无统计学差异。结论:右美托咪定与氯胺酮联合用药提高了术前镇静的成功率,缩短镇静起效时间,是一种安全有效、方便易行的小儿术前用药方法。Objective：To evaluate the effect and security of intranasal dexmedetomidine combined with ketamine on preoperative sedation in children.Methods：From 1 March to 30 June,2016,115 children of ASA I-Ⅱ,aged 2 to 6 years,scheduled to undergo uvulopalatopharyngoplasty and tonsillectomy,were randomly assigned to four equal groups.Group D1（n =37） and Group D2（n =40）received intranasal dexmedetomidine of 1 μg/kg or 2 μg/kg,respectively.Group D1 ＋K（n =38） and Group D2 ＋K（n =40） received dexmedetomidine of 1 μg/kg or 2 μg/kg in one nostril,and intranasal ketamine of 1 mg/kg in the other nostril,respectively.Children were transferred to the operating room 40 minutes later,and received general anaesthesia;after surgery they were sent to the post anesthesia care unit（PACU）.The mean arterial pressure,oxygen saturation and heart rate of patients were recorded every 15 minutes after intranasal administration.Sedation score（modified observer＇s assessment of alertness/sedation score,m OAAS）was recorded at 2 time points：transferred to the operating room（T1）,and received anesthesia induction（T2）.Onset time,duration of anesthesia,duration of surgery,recovery time,pediatric anesthesia emergence delirium scale（PEAD）,postoperative pain score（face,legs,activity,crying,consolability scale,FLACC）and adverse reactions were also recorded.Results：There was no differences in demographic characteristics,duration of anesthesia,and duration of surgery between 4 groups.The onset time of sedation was significantly shorter in group D2＋K than that in group D1,D2 and D1＋K（P〈0.05）.In T1 and T2,the success rate of sedation improved significantly in group D2＋K than in group D1,D2 and D1＋K（P〈0.01）.The incidence of brachycardia was significantly higher in Group D2 compared with that in other 3 groups（P〈0.05）.There was no statistical difference in the recovery time,PEAD and postoperative pain score between 4 groups.Conclusion：Intranasal dexmedetomidine combined with ketami

关 键 词：右美托咪定 氯胺酮 术前镇静 小儿 

分 类 号：R726[医药卫生—儿科]