右美托咪定术前喷鼻在小儿尿道下裂手术中的临床效果

Effect of intranasal dexmedetomidine as premedication on perioperation in pediatric patients undergoing surgery of repairing hypospadias

目的评价右美托咪定（Dex）术前喷鼻在小儿尿道下裂手术中的临床效果。方法择期行尿道下裂手术的患儿共90例,年龄2~6岁,采用随机数字表法分成3组,每组30例。A组患儿于麻醉诱导前30 min将咪达唑仑0.2mg/kg进行喷鼻;B组和C组患儿分别于麻醉诱导前30 min将Dex 1.0μg/kg或2.0μg/kg进行喷鼻。记录3组患儿基础值（T_0）、给药后5 min（T_1）、给药后15 min（T_2）、给药后25 min（T_3）、麻醉诱导后10 min（T_4）、手术开始后30 min（T_5）、术毕（T_6）及术后30 min（T_7）时的心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO_2）及脑电双频指数（BIS）。于T_（0~3）时对3组患儿进行警觉与镇静评分（OAA/S评分）,记录3组患儿与家长分离时镇静情绪评分和静脉穿刺接受程度评分。记录3组患儿术后躁动评分及其它不良反应发生率。结果与A组和B组同时点比较,C组患儿T_（2~3）时的OAA/S评分均降低（P〈0.05）,且T_（2~3）、T_（6~7）时的HR、MAP及BIS均降低（P〈0.05）。与A组和B组比较,C组患儿与家长分离时的镇静情绪评分及静脉穿刺接受程度评分均升高（P〈0.05）,而麻醉诱导时间和麻醉苏醒时间均缩短（P〈0.05）。与A组和B组同时点比较,C组患儿术后10 min、30 min时的躁动评分均下降（P〈0.05）。B组和C组患儿喷鼻刺激发生率均低于A组（P〈0.05）。3组患儿术后其它不良反应如窦性心动过缓、低血压、恶心呕吐、舌后坠、嗜睡及呼吸抑制等的发生率差异均无统计学意义（P〉0.05）。结论 Dex（2.0μg/kg）术前喷鼻用于小儿尿道下裂手术能提供更为满意的术前镇静效果,发挥较好的术后镇静和镇痛效应,并更有效地降低术后躁动的发生率。

Objectiye To explore the effect of intranasal dexmedetomidine（Dex）as premedication on perioperation in pediatric patients undergoing surgery of repairing hypospadias. Methods Using a computer - generated randomization schedule,ninety pediatric patients aged from 2 to 6 years,scheduled to surgery of repairing hypospadias,were enrolled and diveded into three groups,30 cases per group. Children were pre-treated midazolam with 0. 2 mg/ kg by nasal drip at 30 min before anesthesia induction in group A. Children received intranasally dexmedetomidine with either 1. 0 or 2. 0 μg/ kg at 30 min before anesthesia induction in group B or group C,respectively. Heart rate（HR）,mean arterial blood pressure（MAP）,pulse oxygen saturation（SpO2 ）and bispectral index（BIS）were recorded at baseline（T0 ）,at 5 min（T1 ）,15 min（T2 ）and 25 min（T3 ）after treatment,at 10 min（T4 ）after anesthesia induction,at 30 min（T5 ）after the beginning of operation,at the end of operation （T6 ）and at 30 min（T7 ）after operation in the three groups. The observerˊs assessment of alertness/ sedation scale（OAA/ S）was performed from T0 to T2 in the three groups. Calm mood score when children and parents separated and venipuncture acceptance score were recorded in the three groups. The incidences of postoperative agitation and other adverse reactions were recorded after treatment in the three groups. Results Compared with group A and group B at the same time point,OAA/ S of children were lower（ P 〈 0. 05）from T2 to T3 ,and HR,MAP and BIS were all low-er（ P 〈 0. 05）from T2 to T3 and from T6 to T7 in group C. Compared with group A and group B,calm mood score when children and parents separated and venipuncture acceptance score were both higher（ P 〈 0. 05）,while time of anesthesia induction and time of anesthesia recovery were both shorter（ P 〈 0. 05）in group C. Compared with group A and group B at the same time point,agitation score were lower（all P 〈 0. 05） at 10 min and 30 min after operation in group C. The rate of intranasal stimulus in group B and group C were both lower（ P 〈 0. 05）than that of group A. There was no statistical significance（ P 〉 0. 05）in the incidence of other postoperative adverse reactions including sinus bradycar-dia,hypotension,nausea and vomiting,glossocoma,somnolence and respiratory depression etc. in the three groups. Conclusion Intranasal Dex（2. 0 μg/ kg）can provide more satisfactory preoperative sedative effect,exert more significant postoperative sedation and analgesia effect and decrease the rate of postoperative agitation more effectively in pediatric patients undergoing surgery of repairing hypospadias.