右美托咪定对小儿经脐单孔腹腔镜疝内环结扎术后行为状况及康复的研究

Effect of Dexmedetomidine on pediatric postoperative behavior and recovery after laparoendoscopic single-site surgery

目的观察右美托咪定对小儿经脐单孔腹腔镜疝内环结扎术后躁动、行为状况及术后康复的影响。方法选择2015年1~7月河北北方学院附属第一医院经脐单孔腹腔镜疝内环结扎术患儿160例,采用区组随机法将患儿随机分为右美托咪定组和生理盐水组,每组各80例。两组患儿分别于建立静脉通路后泵注含1μg/kg右美托咪定的生理盐水稀释液或生理盐水10 mL,泵注时间均为15 min。分别于入恢复室即刻（T_0）、5 min（T_1）、10 min（T_2）、15 min（T_3）采用PEAD、FLACC量表进行麻醉效果评估;随访两组患儿术后1、3、5、7 d行为状况评分。结果随着进入恢复室的时间的延长,两组患儿PAED评分均逐渐降低,T_1、T_2、T_3较T_0降低,且右美托咪定组患儿术后各时点均低于生理盐水组,差异均有高度统计学意义（P〈0.01）;两组患儿随时间延长FLACC评分均逐渐下降,T_1较T_0降低,差异有统计学意义（P〈0.05）,T_2、T_3较T_0降低,差异有高度统计学意义（P〈0.01）,且右美托咪定组患儿术后各时点均低于生理盐水组,差异有统计学意义（P〈0.05或P〈0.01）。随时间延长两组患儿的行为状况评分均下降,术后3 d较术后1 d降低,术后5 d、术后7 d较术后1 d降低,且右美托咪定组患儿术后各时点行为状况评分均低于生理盐水组,差异均有高度统计学意义（P〈0.01）。结论右美托咪定可预防经脐单孔腹腔镜疝内环结扎术患儿术后躁动的发生,术后行为状况良好,有效地减轻了患儿的焦虑和恐惧。

Objective To observe the effect of Dexmedetomidine on the state of postoperative behavior and recovery af- ter surgery. Methods One hundred and sixty children underwent the inner ligation of hernia by laparoendoscopic sin- gle-site surgery from January to July 2015 in the First Affiliated Hospital of Hebei North University were selected, and they were randomly divided into Dexmedetomidine group and saline group by randomized block design, with 80 cases in each group. Children of Dexmedetomidine group and saline group were respectively infused 10 mL normal saline containing Dexmedetomidine with the dose of 1μg/kg and 10 mL normal saline for 15 min after established the venous access. The scores of PEAD and FLACC were used to evaluated the anesthetic effect at the time of enter postanesthesia care unit （To）, and 5 min （T1）, 10 min （T0）, 15 min （T0） after enter postanesthesia care unit. The scores of opera- tive behavior of 1, 3, 5, 7 d after operation were recorded. Results The PAED scores of the two groups were de- creased as the time in recovery room went on, the PAED scores of two groups at the time of T1, T2, T3 were reduced than To, and the PAED scores of Dexmedetomidine group were lower than those of saline group,the differences were statistically significant （P 〈 0.01）. The FLACC scores of the two groups were decreased as the time in recovery room went on, the FLACC scores of two groups at the time of T1 were reduced than T0, the differences were statistically sig-nificant（P 〈 0.05）. The FLACC scores of two groups at the time of T2, T3 were reduced than T0, the differ- ences were statistically significant （P 〈 0.01） ; and the FLACC scores of Dexmedetomidine group were lower than those of saline group, the differences were statistically significant （P 〈 0.01）. The postoperative behavior score of the two groups were decreased as the time in recovery room went on, the behavior scores of two groups at the time of 3 d after operation were reduced than 1 d after operation, the behavior scores of two groups at the time of 5 d after opera- tion, 7 d after operation were reduced than 1 d after operation, and the behavior scores of Dexmedetomidine group were lower than those of the saline group, the differences were statistically significant （P 〈 0.05, P 〈 0.01）. Conclu- sion Dexmedetomidine can prevent emergence agitation of the children who underwent the inner ligation of hernia by laparoendoscopic single-site surgery, postoperative behavior is in good condition, and alleviate the anxiety and fear effectively.