右美托咪定滴鼻用于小儿腹腔镜疝囊高位结扎术的临床观察  

Intranasal administration of dexmedetomidine in pediatric patients undergoing laparoscopic high ligation for incarcerated inguinal hernia

作　　者：孙志强 李蒙蒙[1] 纪淑敏 张爱莲 蔡红苗[1] 王乔 王清秀 SUN Zhi-qiang;LI Meng-meng;JI Shu-min;ZHANG Ai-lian;CAI Hong-miao;WANG Qiao;WANG Qing-xiu(Dept.of Anesthesiology,East Hospital,Tongji University School of Medicine,Shanghai 200120,China;Dept.of Anesthesiology,Ningbo Women and Children Hospital,Ningbo 315010,Zhejiang Province,China)

机构地区：[1]同济大学附属东方医院麻醉科,上海200120 [2]浙江省宁波市妇女儿童医院麻醉科,浙江315010

出　　处：《同济大学学报（医学版）》2020年第6期779-783,共5页Journal of Tongji University(Medical Science)

基　　金：上海市浦东新区卫生系统重要薄弱学科建设项目(PWZbr017-18)。

摘　　要：目的探讨不同剂量右美托咪定(dexmedetomidine,Dex)滴鼻对腹腔镜疝囊高位结扎术小儿的影响。方法选取90例拟行腹腔镜疝囊高位结扎术患儿,随机分为3组(A组、B组和C组),每组30例。麻醉诱导前30 min,A组经鼻滴入右美托咪定(1μg/kg),B组经鼻滴入右美托咪定(2μg/kg),C组为经鼻滴入等量生理盐水。记录患儿滴鼻前即刻(T 0)、滴鼻后10 min(T 1)、滴鼻后20 min(T 2)、麻醉诱导时(T 3)、手术开始时(T 4)、拔出喉罩时(T 5)的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)和血氧饱和度(saturation pulse oxygen,SpO 2),以及麻醉时间、手术时间、诱导期合作表(induction compliance checklist,ICC)评分、儿童苏醒期躁动量表(pediatric anesthesia emergence delirium,PAED)评分、出院后行为问卷(post hospitalization behavior questionnaire,PHBQ)例数和不良反应的发生。结果与A组、C组相比,B组T 2、T 4、T 5时MAP,T 2~T 5时HR显著下降(P<0.05)。与C组相比,A组和B组ICC评分、PAED评分、PHBQ例数显著下降(P<0.05)。三组患儿一般资料、麻醉时间、手术时间、SpO 2及不良反应发生的差异无统计学意义。结论右美托咪定滴鼻用于小儿腹腔镜疝囊高位结扎术,可显著提高麻醉诱导合作度,降低苏醒期躁动和出院后行为改变的发生。术前滴鼻右美托咪定1μg/kg与2μg/kg对MAP和HR影响较小。Objective To investigate the effects of intranasal administration of dexmedetomidine in pediatric patients undergoing laparoscopic high ligation for incarcerated inguinal hernia.Methods Ninety children undergoing laparoscopic high ligation for incarcerated inguinal hernia were randomly divided into 3 groups with 30 cases in each group.The dexmedetomidine 1μg/kg,dexmedetomidine 2μg/kg or the same volume of normal saline was intranasally administered 30 min before anesthesia induction in groups A,B,C,respectively.HR,MAP and SpO 2 were recorded before(T 0),10 min(T 1)and 20 min after(T 2)administration,at the time of induction of anesthesia(T 3),at the beginning of surgery(T 4),and at the time of removal of the laryngeal mask(T 5).Anesthesia time,operation time,induction compliance checklist(ICC),pediatric anesthesia emergence delirium(PAED),post hospitalization behavior questionnaire(PHBQ)and the incidence of adverse events were documented.Results Compared with group A and group C,MAP in group B decreased significantly at T 2,T 4 and T 5,HR decreased significantly at T 2~T 5(P<0.05).Compared with group C,the ICC score,PAED score and PHBQ cases in group A and group B decreased significantly(P<0.05).There were no significant differences in general information,anesthesia time,operation time,SpO 2 and adverse events among the three groups.Conclusion Intranasal administration of dexmedetomidine can increase anesthesia induction compliance,decrease emergence delirium and post hospitalization behavior change in pediatric patients undergoing laparoscopic high ligation for incarcerated inguinal hernia.Compared with dose of 2μg/kg,1μg/kg dexmedetomidine intranasally administered has less effect on MAP and HR.

关 键 词：右美托咪定 诱导期合作 苏醒期躁动 出院后行为改变 

分 类 号：R726.1[医药卫生—儿科]