右美托咪啶经口腔颊黏膜术前用药对全麻患儿苏醒期躁动的影响  

Effects of dexmedetomidine with oral transmucosal on emergence agitation in children with general anesthesia

作　　者：袁志浩[1] 韩建阁[2] 王欣悦 YUAN Zhi-hao;HAN Jian-ge;WANG Xin-yue(Department of Anesthesiology,Tianjin Children's Hospital,Tianjin 300074,China;Thoracic Clinical Hospital of Tianjin Medical University)

机构地区：[1]天津市儿童医院麻醉科,300074 [2]天津医科大学胸科临床医院

出　　处：《天津医药》2021年第2期207-211,共5页Tianjin Medical Journal

摘　　要：目的探讨术前经口腔颊黏膜给予单剂量右美托咪啶对七氟醚吸入全麻下行扁桃体(伴或不伴腺样体)射频消融术患儿苏醒期躁动发生率的影响。方法选取90例拟在全麻下行择期扁桃体(伴或不伴腺样体)射频消融术的患儿,随机数字表法分为3组:DEX-Ⅰ组、DEX-Ⅱ组和对照组,各30例。DEX-Ⅰ组和DEX-Ⅱ组分别于术前30min经口腔颊黏膜一次性给予右美托咪啶1μg/kg和2μg/kg,对照组于同一时间点以相同方式给与等量生理盐水。记录患儿术前Ramsay评分,术中的平均动脉压、心率和血氧饱和度,拔管时间,入麻醉后监护室(PACU)后5、10、15、30、45和60 min时的Watcha激动评分和改良OPS疼痛评分(Watcha激动评分≥3分视为发生术后躁动),并记录围术期不良事件的发生情况。结果3组Ramsay镇静评分、手术时长和拔管时间差异无统计学意义。DEX-Ⅰ与DEX-Ⅱ组在入PACU后5、10、15和60 min 4个时间点Watcha激动评分均低于对照组,该2组4个时点评分差异均无统计学意义。入PACU后5、10、15和30 min时DEX-Ⅰ与DEX-Ⅱ组术后改良OPS评分均低于对照组,该2组间上述4个时点评分差异无统计学意义。与对照组相比,DEX-Ⅰ与DEX-Ⅱ组术中心率和平均动脉压明显降低,但在正常临床范围内。3组患儿围术期均未见不良事件的发生。结论术前经口腔颊黏膜一次性给予1~2μg/kg右美托咪啶可以有效降低全麻患儿术后苏醒期躁动的发生率。Objective To investigate the efficacy of premedication with oral transmucosal buccal dexmedetomidine(DEX)on the incidence of emergence agitation in children undergoing tonsillectomy under sevoflurane anesthesia.Methods A total of 90 children who were scheduled for tonsillectomy under general anesthesia were randomly divided into three groups:DEX-Ⅰgroup,DEX-Ⅱgroup and control group,with 30 patients in each group.The DEX-Ⅰgroup and the DEX-Ⅱgroup were given dexmedetomidine 1μg/kg and 2μg/kg via buccal mucosa at 30 minutes before surgery,respectively.The control group was given normal saline in the same manner at the same time point.Preoperative sedation score,intraoperative mean arterial pressure(MAP),heart rate(HR)and oxygen saturation,extubating time,Watcha’s agitation scale at 5 min,10 min,15 min,30 min,45 min and 60 min after admission to post anesthesia care unit(PACU),modified OPS pain score at the same time point and occurrence of perioperative adverse events were recorded.Postoperative agitation was considered when Watcha’s agitation score was≥3.Results There were no significant differences in demographics,preoperative sedation score,duration of operation and extubating time between the 3 groups.The Watcha’s agitation scores at the four time points of 5,10,15 and 60 min after entering PACU were lower in DEX-Ⅰand DEX-Ⅱgroups than those of the control group.There were no significant differences in the four time point scores between DEX-Ⅰgroup and DEX-Ⅱgroup.The modified OPS pain scores at the four time points of 5,10,15 and 30 min after entering PACU were lower in DEX-Ⅰand DEX-Ⅱgroups than those of control group.There were no significant differences in the four time point scores between the two DEX groups.Compared with the control group,the HR and MAP were significantly lower in DEX groups,but within the normal clinical range.No adverse events were observed during perioperative period in all three groups.Conclusion Preoperative administration of dexmedetomidine 1-2μg/kg via the

关 键 词：右美托咪啶 麻醉 全身 苏醒谵妄 口腔颊黏膜 儿童 

分 类 号：R614[医药卫生—麻醉学]