右美托咪定滴鼻对斜视儿童全身麻醉术前焦虑和配合度的影响  

Effect of dexmedetomidine administered intranasally on preoperative anxiety and compliance of children undergoing strabismus surgery by general anesthesia

作　　者：初丽艳[1] 王月 王珊珊[1] 王古岩 Chu Liyan;Wang Yue;Wang Shanshan;Wang Guyan(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,北京100730

出　　处：《中国医刊》2021年第7期748-751,共4页Chinese Journal of Medicine

基　　金：北京市医院管理中心临床医学发展专项“扬帆”计划重点医学专业(ZYLX202103)。

摘　　要：目的观察右美托咪定滴鼻对拟在全身麻醉下做斜视手术儿童术前焦虑和配合度的影响。方法选取2019年6—8月在首都医科大学附属北京同仁医院择期行斜视手术的60例患儿为研究对象,采用随机数字表法分为右美托咪定组和对照组,每组各30例。麻醉诱导前30min,右美托咪定组给予2μg/kg右美托咪定缓慢滴鼻,对照组给予0.02ml/kg的生理盐水缓慢滴鼻。记录两组患儿滴鼻30min后的入睡情况。比较分析两组患儿术前1d、手术当日、麻醉诱导时的改良耶鲁围术期焦虑量表(modified Yale preoperative anxiety scale,mYPAS)评分,麻醉诱导时的麻醉诱导期合作度量表(induction compliance checklist,ICC)评分,术后躁动量表(pediatric anesthesia emergence delirium,PAED)评分、苏醒时间、出恢复室时间,不良反应发生率。结果滴鼻30min后,右美托咪定组有11例患儿入睡,对照组无患儿入睡,两组比较差异有显著性(χ^(2)=12.540,P=0.000)。术前1d,两组患儿的mYRAS评分及mYRAS评分≥40分的例数比较差异均无显著性(P>0.05);手术当日和麻醉诱导时,右美托咪定组患儿的mYRAS评分及mYRAS评分≥40分的例数均显著低于和少于对照组(P<0.05)。麻醉诱导时,右美托咪定组患儿的ICC评分和ICC评分≥4分的例数均显著低于和少于对照组(P<0.05)。术后右美托咪定组患儿PAED评分显著低于对照组(P<0.05),苏醒时间显著长于对照组(P<0.05),两组患儿出恢复室时间比较差异无显著性(P>0.05)。右美托咪定组患儿术后嗜睡的发生率显著高于对照组(P<0.05),右美托咪定组患儿术后烦躁的发生率显著低于对照组(P<0.05)。两组患儿术后疼痛、恶心等不良反应发生率比较差异均无显著性(P>0.05)。结论术前30min采用2μg/kg右美托咪定滴鼻,可明显提升患儿配合度,改善术前焦虑,同时可缓解患儿术后躁动,且安全性较好。术后苏醒时间略有延长,但不影响出恢复室时间。Objective To evaluate the effects of intranasal dexmedetomidine premedication on preoperative anxiety and compliance of children undergoing strabismus surgery.Method 60 patients undergoing strabismus surgery by general anesthesia in Beijing Tongren Hospital,Capital Medical University from June to August 2019 were selected.They were divided into dexmedetomidine group and control group,and 30 patients in each group,according to the random number table.30 mins before anesthesia,all of the patients were premedicated intranasally,2μg/kg dexmedetomidine for dexmedetomidine group,and 0.02ml/kg normal saline for control group.The number of patients falling asleep after intranasal administration,and the modified Yale preoperative anxiety scale(mYRAS)scale of the day before surgery,the day of surgery,and the anaesthesia induction time were recorded,and the induction compliance checklist(ICC)score was evaluated at the anaesthesia induction time.And emergence agitation by the the pediatric anesthesia emergence delirium(PAED)score,awaking time,time to leave the recovery room,and the occurence rates of side effects were all recorded.Result 30 mins after the intranasal administration,11 patients in the dexmedetomidine group fell asleep compared with 0 in control group(χ^(2)=12.540,P=0.000).There was no significant difference between the mYPAS scores of the two groups the day before surgery(P>0.05).The day of surgery and at the anaesthesia induction time,the mYPAS scores and the cases of mYPAS score≥40 of dexmedetomidine group were all significantlly lower than those of control group(P<0.05).The ICC score and the cases of ICC score≥4 of dexmedetomidinegroup were lower than those of control group(P<0.05).The PAED score of dexmedetomidine group was significantlly lower than control group,and the awaking time of dexmedetomidine group were significantlly longer than control group(P<0.05).The time to leave the recovery room of control group was not different from the dexmedetomidine group(P>0.05).The incidence of drowsiness of

关 键 词：右美托咪定 儿童 术前焦虑 配合度 全身麻醉 

分 类 号：R614[医药卫生—麻醉学]