右美托咪定术前滴鼻在小儿斜视手术中的应用

Effect of intranasal dexmedetomidine as premedication in pediatric strabismus surgery

目的:观察右美托咪定滴鼻在小儿斜视手术中的临床应用。方法:择期斜视矫正术患儿60例,随机均分为3组:七氟醚麻醉诱导前30 min分别滴鼻1μg/kg右美托咪定(A组),2μg/kg右美托咪定(B组)和等容积生理盐水(C组)。观察记录3组患者诱导时间及30 min后镇静评分、与父母分离时情绪评分和面罩接受程度;记录苏醒时间、苏醒期躁动发生率并评估躁动程度。结果:B组患儿诱导时间较A组和C组明显缩短(P<0.05);用药30 min后患儿镇静评分和与父母分离时情绪评分为B组>A组>C组(P<0.05);吸入面罩接受评分为B组优于A组和C组(P<0.05);3组患儿的苏醒时间差异无统计学意义(P>0.05);AONO评分、儿童麻醉苏醒谵妄(pediatric anesthesia emergence delirium,PAED)评分和躁动发生率比较均为B组<A组<C组(P<0.05)。结论:2μg/kg右美托咪定术前30 min滴鼻能有效缓解患儿术前焦虑,降低术后躁动的发生率,是一种理想的小儿术前用药选择。

Objective： To investigate the effect of intranasal dexmedetomidine as premedication in pediatric strabismus surgery. Methods： Sixty children undergoing strabismus surgery were equally randomized into 3 groups receiving dexmedetomidine 1 μg/kg（group A）, 2 μg/kg（group B） and the same volume of saline（group C）, 30 min before sevoflurane anesthesia respectively. The time for anesthesia induction was observed; 30 min after premedication, the sedation score, the mood state apart from parents and the receipt score of face mask for anesthesia induction were evaluated; the time for awaken, agitation rate and agitation scores were recorded. Results： The induction time of group B was significantly shorter than group A and group C; the sedation score and the profile of mood state apart from parents were group B〉group A〉group C（P〈0.05）; the receipt score of face mask of group B was higher than group A and group C（P〈0.05）; the agitation rate and the agitation scores were group B〉group A〉group C（P〈0.05）. There was no significant difference in awaken time among three groups. Conclusion： Predication with intranasal dexmedetomidine 2 μg/kg 30 min before surgery produces a good sedation effect and reduces the agitation rate and agitation scores, which may be used as a choice for children premedication.