右美托咪定滴鼻在3岁以下儿童检查镇静中的应用  

Application of dexmedetomidine nasal drops in sedation for examinations in children under 3 years old

作　　者：吴居逸 赵宇燕[1] WU Ju-yi;ZHAO Yu-yan(Department of Pediatric Respiratory,The 2th Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院儿童呼吸科,浙江温州325000

出　　处：《中国妇幼保健》2025年第6期1028-1032,共5页Maternal and Child Health Care of China

基　　金：浙江省温州市基础性医疗科技项目(Y2020717)。

摘　　要：目的探讨右美托咪定滴鼻在3岁以下儿童检查镇静中的应用。方法将2022年1月—2023年10月入住温州医科大学附属第二医院育英儿童医院儿童呼吸科和儿童变态反应(过敏)与免疫科的年龄<3岁且自行配合检查困难,需镇静配合完成检查、ASA分级为Ⅰ、Ⅱ级的患儿100例,随机分为水合氯醛组(Ch组)和右美托咪定组(Dx组)(各50例)。记录两组患儿年龄、性别、体质量、ASA分级、基础疾病及给药前后基本症状体征,包括心率(HR)、血氧饱和度(SpO_(2))、平均动脉压(MAP)。儿科临床镇静评分系统(Ramsay)评价患儿镇静后评分:t_(0):给药前,t_(1):给药后10 min,t_(2):入睡时,t_(3):检查完时,t_(4):苏醒时,记录药物起效时间(T1)、苏醒时间(T2)、各项检查需要时间(T3)及总镇静时间(T4)。记录患儿镇静一次性成功率、在接受药物时是否伴有哭泣,检查后心动过缓、呕吐、嗜睡发生率。结果与给药前相比,给药后两组患儿HR、MAP降低(P<0.05)。给药前,两组患儿HR、MAP比较,差异无统计学意义(P>0.05),给药后,与Ch组相比,Dx组HR降低,MAP升高(tHR=2.811,tMAP=2.725,P<0.05)。两组SpO_(2)比较,差异无统计学意义(P>0.05)。两组患儿在t_(0)时Ramsay评分比较,差异无统计学意义(P>0.05)。t_(1)、t_(2)时Dx组Ramsay评分高于Ch组,t_(3)、t_(4)时Dx组Ramsay评分低于Ch组(t_(t1)=50.640,t_(t2)=4.991,t_(t3)=3.054,t_(t4)=18.100,均P<0.05)。Dx组患儿T1、T2、T4显著低于Ch组(t_(T1)=2.233,t_(T2)=11.570,t_(T4)=2.699,均P<0.05),两组患儿T3比较,差异无统计学意义(P>0.05)。Dx组患儿镇静一次性成功率为96.00%(48/50),Ch组为82.00%(41/50),二者比较差异有统计学意义(χ^(2)=5.005,P<0.05)。Dx组患儿给药时伴哭泣例数为0,Ch组为6例(12.00%),差异有统计学意义(χ^(2)=6.383,P<0.05)。两组患儿检查后心动过缓、呕吐、嗜睡发生率比较,差异无统计学意义(P>0.05)。结论在3岁以下患儿检查镇静中,与水合氯醛灌肠相比Objective To explore the application of dexmedetomidine nasal drops in sedation for examinations in children under 3 years old.Methods A total of 100 children who were admitted to the Department of Pediatric Respiratory Medicine and the Department of Pediatric Allergy and Immunology of the Second Affiliated Hospital&Yuying Children's Hospital of Wenzhou Medical University from January 2022 to October 2023,were less than 3 years old,had difficulty in cooperating with examinations on their own,required sedation to complete examinations,and had American Society of Anesthesiologists(ASA)physical status classification of gradeⅠorⅡ,were randomly divided into the chloral hydrate group(group Ch)and the dexmedetomidine group(group Dx)(50 cases in each group).The age,gender,body mass,ASA classification,underlying diseases,and basic symptoms and signs before and after drug administration,including heart rate(HR),oxygen saturation(SpO_2),and mean arterial pressure(MAP),were recorded for the children in both groups.The Pediatric Clinical Sedation Score System(Ramsay)was used to evaluate the scores of the children after sedation:t_(0):before drug administration,t_(1):10 minutes after drug administration,t_(2):at the time of falling asleep,t_(3):at the completion of the examination,t_4:at the time of awakening.The onset time of the drug(T1),the awakening time(T2),the time required for each examination(T3),and the total sedation time(T4)were recorded.The one-time success rate of sedation,whether the children cried when receiving the drug,and the incidences of bradycardia,vomiting,and somnolence after the examination were also recorded.Results Compared with before drug administration,the HR and MAP of the children in both groups decreased after drug administration(P<0.05).Before drug administration,there was no significant difference in HR and MAP between the two groups of children(P>0.05).After drug administration,compared with group Ch,the HR in group Dx decreased and the MAP increased(t_(HR)=2.811,t_(MAP)=2.725,P<0.05).The

关 键 词：右美托咪定滴鼻 儿童检查 镇静评分 一次性镇静成功率 

分 类 号：R725[医药卫生—儿科]