右美托咪定对扁桃体腺样体切除术后儿童全麻苏醒期躁动和谵妄的影响  

Dexmedetomidine reduces emergence agitation and delirium in children undergoing tonsillectomy and adenoidectomy under general anesthesia

作　　者：姚汉青 刘林[1] 钱兴华[1] 胡惠静 夏丰[1] YAO Hanqing;LIU Lin;QIAN Xinghua;HU Huijing;XIA Feng(Authors'address:Department of Anesthesiology,Jiaxing Maternal and Child Health Care Hospital,Jiaxing 314000,China)

机构地区：[1]嘉兴市妇幼保健院麻醉科,314000

出　　处：《浙江医学》2022年第11期1192-1197,共6页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技面上项目(2020KY964)。

摘　　要：目的评价右美托咪定预防儿童全麻下扁桃体腺样体切除术后苏醒期躁动(EA)和苏醒期谵妄(ED)的安全性和有效性。方法选择嘉兴市妇幼保健院2020年7月至2021年8月在全麻下行扁桃体腺样体切除术3~8岁儿童100例。按随机数字表法分为静脉注射右美托咪定0.25、0.5、1.0μg/kg组(D1、D2、D3组)和0.9%氯化钠注射液组(对照组)。4组患儿均在气管插管全麻下行扁桃体腺样体切除术,气管插管麻醉后分别输注右美托咪定或0.9%氯化钠注射液。观察并比较4组患儿术后2 h EA和ED的发生率及儿童和婴儿术后疼痛量表(CHIPPS)评分、术中七氟烷消耗量、手术时间、麻醉结束到气管导管移除之间的时间(TE)、主动睁眼时间(TA)、麻醉后监护病房(PACU)停留时间(TP)、以及各时点心率(HR)、平均动脉压(MAP)。记录有无喉痉挛、呼吸抑制、心律失常和呕吐等麻醉不良反应发生情况。结果D2组和D3组患儿术后CHIPPS量表评分明显低于D1组和对照组,差异均有统计学意义(均P<0.05);D2组和D3组患儿EA、ED发生率明显低于对照组,差异均有统计学意义(均P<0.05)。D2组和D3组术中七氟烷消耗量明显低于对照组和D1组,差异均有统计学意义(均P<0.05)。与对照组比较,D2和D3组TE、TA以及TP的间隔时间显著延长,D3组TP更长,差异均有统计学意义(均P<0.05)。与T1时点比较,D3组MAP在T2时升高,在T3时下降,而D3组HR在T2~T7时点均明显下降,差异均有统计学意义(均P<0.05)。D1组有1例患儿因过早停药引起严重喉痉挛,其余各组均未观察到麻醉不良反应发生。结论儿童在扁桃体腺样体切除术中使用右美托咪定术后EA、ED的发生率明显下降,疼痛明显减轻,所需七氟烷消耗量也显著减少。Objective To evaluate the safety and efficacy of dexmedetomidine in the prevention of emergence agitation(EA)and emergence delirium(ED)in children undergoing tonsillectomy and adenoidectomy under general anesthesia.Methods One hundred children aged 3-8 years who underwent tonsillectomy and adenoidectomy under general anesthesia in Jiaxing Maternal and Child Health Care Hospital from July 2020 to August 2021 were enrolled.Patients were randomly assigned into 4 groups and received intravenous injection of dexmedetomidine 0.25,0.5,1.0μg/kg(group D1,D2,D3 respectively)and 0.9%sodium chloride injection(control group)after tracheal intubation anesthesia,respectively.The inci-dences of EA and ED and children's and infants'postoperative pain scale(CHIPPS)scores at 2 h after operation were evaluated and compared among four groups.Intraoperative sevoflurane consumption,operation duration,time between the end of anesthesia and endotracheal tube removal(TE),active eye-opening time(TA),PACU retention time(TP),heart rate(HR),mean arterial pressure(MAP)were documented and compared.The occurrence of adverse reactions to anesthesia in cluding laryngospasm,respiratory depression,arrhythmia and vomiting were recorded.Results The postoperative CHIPPS scores in D2 group and D3 group were significantly lower than those in D1 group and control group(all P<0.05).The incidence of EA and ED in D2 group and D3 group was significantly lower than that in D1 group and control group(all P<0.05).The intraoperative consumption of sevoflurane in D2 and D3 groups was significantly lower than that in the control group and D1 group(all P<0.05).Compared with the control group,the interval time of TE,TA and TP in D2 and D3 groups was significantly prolonged,and the TP in D3 group was even longer(all P<0.05).Compared with the D1 group,D2 group and the control group,the HR in D3 group was significantly decreased at the time points from T2 to T7,and the MAP in D3 group was significantly different at the time points T2 and T3(all P<0.05).There was one ch

关 键 词：右美托咪定 苏醒期躁动 苏醒期谵妄 扁桃体腺样体切除术 全身麻醉 儿童 

分 类 号：R726.1[医药卫生—儿科]