右美托咪定术前滴鼻对全麻患儿术后行为改变的影响

Effects of intranasal dexmedetomidine as premedication on postoperative behavioral outcomes in children

目的观察右美托咪定术前滴鼻对全麻患儿术后行为改变的影响。方法择期在全麻下行疝囊高位结扎术的患儿60例,男46例,女14例,年龄2-5岁,体重10-30kg,ASAⅠ或Ⅱ级。采用随机数字表法,将其均分为三组：对照组（C组）、咪达唑仑组（M组）和右美托咪定组（D组）。麻醉诱导前30min,C组生理盐水0.02ml/kg滴鼻,M组咪达唑仑0.2mg/kg滴鼻,D组右美托咪定2μg/kg滴鼻。记录患儿与父母分离时的镇静评分及七氟醚诱导时的面罩接受程度评分;记录患儿术后恢复时间、术后并发症及镇痛药补救率等情况。分别在术前1d、术后1、7、30d用术后行为量表（PHBQ）对患儿父母进行术前问卷调查及术后电话随访,观察患儿术后行为改变的情况。结果M组和D组与父母分离时的镇静评分及七氟醚诱导时的面罩接受程度评分明显高于C组（P〈0.05）。D组苏醒期躁动、恶心呕吐及镇痛药补救率明显低于C组和M组（P〈0.05）。术后1、7d时M组和D组行为改变的发生率明显低于C组（P〈0.05）。结论右美托咪定术前滴鼻可以降低全麻患儿术后行为改变的发生率。

Objective To observe the effects of intranasal dexmedetomidine（DM）as premedication on postoperative behavioral outcomes in children.Methods Sixty ASA physical statusⅠ orⅡchildren of both genders,2-5years,weighing 10-30 kg,undergoing hernia surgery,were equally assigned into three groups（n=20each）using a random number table：control group（group C）,midazolam group（group M）and dexmedetomidine group（group D）.Thirty minutes before anesthesia induction,the children were respectively received intranasal normal saline 0.02 ml/kg（group C）,intranasal midazolam 0.2mg/kg（group M）and intranasal DM 2μg/kg（group D）.The sedation score of children apart from parents,the receipt score of face mask for sevoflurane anesthesia induction,the postoperative recovery time,adverse effects,and the percentage of patients requiring rescue analgesic were recorded.To observe the postoperative behavioral outcomes on 1th、7th、30th day using the PHBQ.Results Compared with group C,the sedation score and the receipt score of face mask of groups M and D were significantly increased（P〈0.05）.Compared with groups C and M,the adverse effects and the percentage of patients requiring rescue analgesic of group D were decreased（P〈0.05）.The incidence of the postoperative behavioral outcomes of group C was higher than groups M and D on1 th,7th day（P〈0.05）.And on 30 th day after operation,there was no significant difference among three groups.Conclusion Intranasal dexmedetomidine as premedication can significantly decrease the incidence of the postoperative behavioral outcomes in children.