鼻内滴注右美托咪定与咪达唑仑用于泌尿外科小儿术前用药效果的比较  

Comparison of Intranasal instillation of dexmedetomidine and midazolam for premeditation in children undergoing urological surgery

作　　者：顾晓霞 王晶晶 卢悦 蔡树云 陈金仙 GU Xiao-xia;WANG Jing-jing;LU Yue;CAI Shu-yun;CHEN Jin-xian(Department of Anesthesiology,The Affiliated Hospital of Guangdong Medical University,Zhanjiang,Guangdong 524001)

机构地区：[1]广东医科大学附属医院麻醉科,广东湛江524001

出　　处：《赣南医学院学报》2020年第4期400-404,共5页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：广东医科大学科研基金项目(M2017037)。

摘　　要：目的:比较鼻内滴注右美托咪定与咪达唑仑用于泌尿外科患儿术前用药的效果。方法:择期行泌尿外科手术的患儿80例,年龄1~6岁,ASAⅠ~Ⅱ级,随机分为:咪达唑仑组(A组)和右美托咪定组(B组)各40例。于麻醉诱导前约30 min由家长陪同进入麻醉准备室。分别给予咪达唑仑0.2 mg·kg^-1或右美托咪定1μg·kg^-1滴鼻预处理。采用丙泊酚-阿曲库铵-芬太尼行麻醉诱导,七氟醚-芬太尼-阿曲库铵维持麻醉。于用药前(T1)、与家长分离(T2)和进入手术室(T3)时记录改良耶鲁术前焦虑评分(mYPAS)、镇静评分、HR、MAP、RR、SPO2。于T2、T3时记录患儿进入睡眠状态(镇静评分4分)的发生情况。记录七氟醚及芬太尼用量、拔管时间、意识恢复时间、麻醉恢复室观察时间、苏醒期谵妄发生率、补救镇痛药使用率及不良反应的发生情况。结果:与T1时比较,两组T2、T3时mYPAS评分降低、镇静评分升高;B组T2时HR及T2、T3时MAP降低,A组T3时HR升高(P<0.05);与A组比较,B组T2、T3时镇静评分和睡眠发生率升高;T2时HR降低(P<0.05),七氟醚及芬太尼用量减少(P<0.05),MAP、RR、SPO2、拔管时间、意识恢复时间、麻醉恢复室观察时间、苏醒期谵妄发生率、补救镇痛药使用率、不良反应发生率比较差异无统计学意义(P>0.05)。结论:鼻内滴注右美托咪定用于患儿术前用药的镇静效果优于咪达唑仑,并能减少麻醉用药量,但需注意对心率的影响。Objective:To compare the efficacy of intranasal instillation of dexmedetomidine and midazolam for premedication in children undergoing urological surgery.Methods:Eighty ASAⅠorⅡchildren scheduled for urologic surgeries were enrolled in this sludy.the children were randomly divided into 2 groups(n=40 each):midazolam group(group A)and dexmedetomidine group(group B).The children accompanied by their parents were admitted to the anesthesia preparation room at about 30 min before induction of anesthesia.and midazolam 0.2 mg·kg^-1 or dexmedetomidine 1μg·kg^-1 was intranasal instillation.Anesthesia was induced with proporol-atracurium-fentanyl,and maintained with sevoflurane-fentanyl-atracurium.Modified Yale Preoperative Anxiety Scale(mYPAS)score,sedation score,HR,mean arterial pressure(MAP),respiratory rate(RR)and SPO 2 were recorded before premedication(T 1),before separation from their parents(T 2)and when entering the operating room(T 3).The incidence of sleep(a sedation score of 4)was recorded at T 2,T 3.The total dosage of sevoflurane and fentany,time of tracheal extubation,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patients requiring rescue analgesic,and adverse effects were also recorded.Results:Compared to that at T 1,the mYPAS score was significantly decreased at T 2,T 3,and the sedation score was significantly increased at T 2,T 3 in both groups(P<0.05),HR at T 2 and MAP at T 2,T 3 were significantly decreased in group B,and HR at T 3 was significantly increased in group A(P<0.05).Compared to group A,the sedation scores and the incidence of sleep were significantly increased at at T 2,T 3,and the HR was significantly decreased at T 2 in group B(P<0.05),the total dosage of sevoflurane and fentanyl were reduced(P<0.05).There was no significant difference in the mYPAS score,RR,MAP,SPO 2,time of tracheal extubation,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patien

关 键 词：右美托咪定 咪达唑仑 麻醉前用药 鼻内滴注 儿童 

分 类 号：R614[医药卫生—麻醉学]