右美托咪定滴鼻对小儿术前镇静及吸入麻醉诱导的影响

EFFECTS OF PREMEDICATED DEXMEDETOMIDE NASAL DROPS ON PREOPERATIVE SEDATION AND ANESTHESIA INDUCTION WITH INHALED ANESTHETICS IN CHILDREN

目的观察术前右旋美托咪定滴鼻对患儿术前镇静及吸入麻醉诱导配合程度的影响。方法选择1-8岁白内障患儿45例,随机分为3组：Ⅰ组（生理盐水对照组）、Ⅱ组（1μg/kg组）及Ⅲ组（2μg/kg组）,每组15例。在麻醉前,Ⅱ组及Ⅲ组分别经鼻滴入1或2μg/kg右美托咪定,Ⅰ组给予等容积的生理盐水。监测给药前（t0）、入睡后（t1）及入手术室后（t2）患儿心率、血氧饱和度的变化,并记录患儿入睡时间、镇静评分、行为评分;评估并记录患儿和父母分离评分、面罩诱导质量评分。结果Ⅲ组患儿入睡时间明显短于Ⅱ组（p〈0.05）;Ⅱ组、Ⅲ组镇静评分、行为评分、分离评分及面罩诱导评分明显低于Ⅰ组（p〈0.05）;且Ⅱ组及Ⅲ组使用其他静脉诱导药物的比例明显低于Ⅰ组（p〈0.05）;Ⅱ组、Ⅲ组间比较无明显差异（p〉0.05）。3组患儿在t0、t1、t2时刻血氧饱和度无明显变化（p〉0.05）;Ⅰ组患儿心率在t2时刻明显高于Ⅱ组、Ⅲ组（p〈0.05）。结论 1μg/kg或2μg/kg右美托咪定滴鼻均可安全应用于小儿术前镇静,可明显改善麻醉诱导质量并不增加呼吸抑制等并发症,2μg/kg镇静效果更佳。

Objective To observe the effects of premedicated dexmedetomide nasal drops on preoperative sedation and anesthesia induction with inhaled anesthetics in children. Methods 45 cataract children aged 1 ~ 8years were randomized equally into 3 groups： group I（ the normal saline control group）,group II（ the1 μg / kg of dexmedetomide group）,and group III（ the 2 μg / kg of dexmedetomide group）. The children were given 1 or 2 μg / kg of dexmedetomidine nasally in groups II or III before anesthesia while group I was received the same volume of normal saline. Changes of heart rates（ HR）,oxyhemoglobin saturation（ Sp O2） in children before medication（ t0）,after falling asleep（ t1） and entering the operating room（ t2） were detected. The time of falling asleep,sedation scores and behavior scores were recorded. The scores of children apart from their parents and the quality scores of face mask induction were evaluated and recorded. Results The time of falling asleep in group III was significantly shorter than that in group II（ p〈0.05）. The sedation scores,behavior scores,separation scores and scores on face mask induction in groups II and III were significantly lower than those in group I（ p〈0.05）. The percentages of other intravenously- induced drugs in groups II and III were significantly lower than that in group I（ p〈0.05）,but with no significant difference between groups II and III（ p〈0.05）. Sp O2 in the three groups at t0,t1 and t2had no significant changes（ p〈0.05）. HR in group I at t2 was significantly higher than those in groups II and III（ p〈0.05）. Conclusion 1 or 2 μg / kg of premedicated dexmedetomide nasal drops can be safely administrated to reduce pediatric anxiety and significantly improve the quality of anesthesia induction without complications such as respiratory depression. The optional dase for its was 2 μg / kg.