不同剂量右美托咪定滴鼻对先天性耳聋患儿术前行程序性镇静的效果比较  

A randomised comparison of different intranasal dexmedetomidine doses for preoperative procedural sedation in congenital deafness children

作　　者：夏俊明 薛期能 陆瑾 沈霞 XIA Jun-ming;XUE Qi-neng;LU Jin;SHEN Xia(Department of Anesthesiology,Eye and ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,上海200031

出　　处：《复旦学报（医学版）》2023年第5期700-704,共5页Fudan University Journal of Medical Sciences

摘　　要：目的观察不同剂量右美托咪定滴鼻对行电子耳蜗植入术的先天性耳聋患儿术前镇静的效果。方法将择期行电子耳蜗植入术的先天性耳聋患儿(8~24月龄)随机分为右美托咪定3μg/kg组(n=81)和5μg/kg组(n=83),在手术前30 min经鼻滴入右美托咪定。采用5分法镇静评分量表评估给药后30 min内镇静成功率,其他观察指标包括:镇静起效时间、患儿和监护人分离时镇静评分≥3分及面罩七氟醚吸入诱导时镇静评分达到4分的人数、麻醉诱导时间、镇静期间心动过缓以及呼吸抑制的发生情况。结果两组患儿一般情况无显著差异,30 min内两组患儿镇静成功率均达100%。与右美托咪定3μg/kg组患儿相比,5μg/kg组患儿镇静起效时间缩短(12 min vs.17 min,P=0.001);与监护人分离时镇静评分≥3分(78.3%vs.61.7%,P=0.026)及面罩七氟醚吸入诱导时镇静评分达到4分的人数均增加(30.1%vs.4.9%,P<0.001);麻醉诱导时间缩短(8.6 min vs.11.2 min,P<0.001);围术期未发生呼吸抑制和去氧合等不良事件。结论右美托咪定3μg/kg或5μg/kg滴鼻均可在30 min内对患儿成功实施术前程序性镇静。使用5μg/kg右美托咪定可以缩短耳聋患儿的镇静起效时间、提升镇静的满意比例,无严重循环和呼吸系统不良事件。Objective To evaluate the efficacy using intranasal dexmedetomidine with different doses for preoperative sedation in congenital deafness children.Methods Congenital deafness children(8-24 months)scheduled for cochlear implantation were randomly assigned into dexmedetomidine 3μg/kg group(n=81)and 5μg/kg group(n=83)for sedation 30 minutes before operation.The primary outcome was the proportion of children attaining sedation success with a 5-point rating scale.The second measurements were onset time of sedation,number of patients with sedation score≥3 at separation,number of patients with a sedation score of 4 at mask stimulation,duration of anesthesia induction,adverse events such as bradycardia and desaturation.Results Patients in both groups were all successfully sedated in 30 minutes after dexmedetomidine administration intranasally.Compared with the patients receiving dexmedetomidine of 3μg/kg,onset time was shorter(12 min vs.17 min,P=0.001),the number of patients with a sedation score≥3 at separation(78.3%vs.61.7%,P=0.026)and patients with a sedation score of 4 at mask stimulation during anesthesia induction(30.1%vs.4.9%,P<0.001)were higher,duration of anesthesia induction was shorter(8.6 min vs.11.2 min,P<0.001)in the patients receiving dexmedetomidine of 5μg/kg.No severe adverse events occurred perioperatively.Conclusion Either dexmedetomidine 3μg/kg or 5μg/kg provided successful sedation within 30 minutes after administration intranasally.A higher dose was associated with a shorter onset time,higher proportion of satisfactory sedation at separation and mask stimulation but without severe adverse events.

关 键 词：先天性耳聋 术前镇静 右美托咪定 不良反应 儿童 

分 类 号：R614[医药卫生—麻醉学]