麻醉诱导后经鼻给予右美托咪定对眼科手术患儿苏醒期躁动影响的随机对照试验

Randomized controlled trial on influence of nasal administration of dexmedetomidine after induction of anesthesia on agitation of children in ophthalmologic surgery

目的观察麻醉诱导后经鼻给予右美托咪定对全身麻醉手术患儿苏醒期躁动的影响。方法研究设计为随机对照试验。将2015年3至10月在我院眼科接受手术治疗的患儿用随机数字表法分为右美托咪定组和对照组。所有患儿麻醉诱导后置入喉罩，经鼻给药使用LMAMADNasal，右美托咪定组喷入盐酸右美托咪定注射液1μg／kg，对照组喷入0．9％氯化钠注射液0．01ml／kg。术前用Ibrahim4点评分法评价患儿与家长分离状况。记录患儿麻醉诱导前即刻、置入喉罩后2min、给药后10min、手术开始后10min、术毕的心率、收缩压、呼吸频率及脉搏血氧饱和度（SpO2）以及麻醉时间、手术时间和麻醉后恢复室（PACU）停留时间。术后采用Sundaram4点评分法评估患儿苏醒时状态。结果共97例患儿纳入研究，右美托咪定组47例，对照组50例。2组患儿年龄、性别分布和体重差异均无统计学意义（均P〉0．05）。术前右美托咪定组和对照组患儿出现与父母分离困难者分别为26例（55．3％）和18例（36．0％），差异无统计学意义（P=0．216）。2组患儿围术期不同时点心率、收缩压、呼吸频率、SpO2以及麻醉时间、手术时间和PACU停留时间差异均无统计学意义（均P〉0．05）。右美托咪定组患儿术后苏醒时躁动发生率低于对照组[14．9％（7／47）比40．0％（20／50）]，差异有统计学意义（P=0．007）。结论麻醉诱导后经鼻给予右美托咪定（1μg／kg）可有效降低全身麻醉手术患儿苏醒期躁动发生率，有利于患儿的术后护理和恢复。

Objective To observe the influence of nasal administration of dexmedetomidine after induction of anesthesia on agitation of children in ophthalmologic surgery. Methods The study was designed as a randomized, double-blind and controlled trial. The children who underwent the ophthalmologic surgery in Department of Ophthalmology, Beijing Tongren Hospital from March to October 2015 were divided into the dexmedetomidine group and the control group by a table of random number. After the induction of anesthesia, all the children received the laryngeal mask （LMA） and the intranasal drugs were sprayed through the nasal mucosal drug delivery device （LMA MAD NasalTM）. The dexmedetomidine group received hydrochloride dexmedetomidine injection （ 1 μg/kg） and the control group received 0.9% sodium chloride injection （0.01 ml/kg）. The separation condition between the children and the parents in the 2 groups were judged by Ibrahim＇s 4 comment method before operation. The children＇s heart rate, systolic blood pressure, respiratory frequency and pulse oxygen saturation （SpO2 ） were recorded at the different time points （before induction momentarily, 2 minutes after laryngeal mask insertion, 10 minutes after giving the intranasal drugs, 10 minutes after the starting of operation and the end of operation, respectively）. The anesthesia time, operation time, staying time in post anesthesia care unit （PACU） and postoperative emergence agitation were also recorded. The children＇waking condition in PACU were evaluated by Sundaram＇s 4-point score after operation. Results A total of 97 children were enrolled in this study. The dexmedetomidine group comprised 47 cases and the control group 50 cases. The differences in age, sex and body weight between the 2 groups were not statistically significant （ all P 〉 0.05 ）. The number of cases who had separation difficulty in the dexmedetomidine group and the control group were 26 （55. 3% ） and 18 （36.0%）, respectively. The differences was not statistically significant. The differences in heart rate,systolic pressure; respiratory frequency, SpO2 and staying time in PACU between the children in the 2 groups at different time points during perioperative period were not statistically significant （ all P 〉 0.05 ）. The incidence of emergence agitation during recovery period in the dexmedetomidine group was lower than that in the control group [ 14.9% （7/47） vs 40.0% （20/50） ], and the difference was statistically significant （P = 0. 007）. Conclusion Nasal administration of dexmedetomidine after induction of anesthesia （ 1μg/kg） may decrease the incidence of emergence agitation during recovery period after general anesthesia and be propitious to children＇postoperative recovery,