右美托咪定滴鼻用于日间手术苏醒期临床疗效观察

Clinical observation of dexmedetomidine given intranasally for day surgery recovery period

目的 探讨右美托咪定滴鼻用于日间手术苏醒期的临床疗效观察.方法 选择择期行日间手术的60例小儿患者为研究对象,按照随机数字表法分为对照组及观察组,每组30例.入室后吸入8%的七氟烷流量8 L/min诱导,以3%七氟烷1 L/min维持,喉罩插入固定好后观察组给予0.5 μg（右美托咪定滴鼻,对照组给予等毫升量0.9%氯化钠注射液滴鼻.观察两组患儿不同时刻的平均动脉压（MAP）、心率（HR）和血氧饱和度（SpO2）;观察两组患儿苏醒时间、发生躁动例数、Aono躁动评分、儿童麻醉苏醒谵妄PAED评分以及治疗过程中不良反应的发生情况.结果 随着术后时间的增加,两组患儿MAP、HR、SpO2趋于平稳,T0时刻观察组患儿HR（92.92±3.22）次/min高于对照组的（89.32±3.22）次/min,差异有统计学意义（t=2.34,P＜0.05）,其余时刻两组MAP、HR、SpO2比较差异均无统计学意义（均P＞0.05）.观察组患儿苏醒时间长于对照组[（20.55±0.97）min比（18.62±1.03）min,t=2.17,P＜0.05）],躁动例数、Aono躁动评分、童麻醉苏醒谵妄PAED评分均低于对照组患儿（t=5.38、3.72、2.56,均P＜0.05）.两组患儿在治疗中总不良反应的发生率比较差异无统计学意义（13.33%比10.00%,x2=0.12,P＞0.05）.结论 右美托咪定滴鼻用于行日间手术的患儿可显著改善苏醒期质量,总体可降低术后谵妄的发生率,且无明显药物副作用.

Objective To evaluate the clinical efficacy of dexmedetomidine given intranasally for day surgery recovery period.Methods 60 pediatric patients who were treated for elective day surgery were selected as study objects,and they were randomly divided into control group and observation group according to the digital table,30 cases in each group.During operation, after induction of 8% sevoflurane inhalation at 8 L/min,3% of sevoflurane was maintained at 1 L/min.After intubation,0.5 g dexmedetomidine was given intranasally in the observation group, 0.9% NaCl saline was given to the control group.Mean arterial pressure （MAP）,heart rate （HR）,oxygen saturation （SpO2） were observed at different time points.The recovery time, number of cases of agitation, Aono agitation scale, children anesthesia delirium PAED score and the incidence of adverse reactions were observed in the two groups.Results As the time passed by, the MAP,HR,SpO2 in the two groups stabilized, except HR of the observation group at T0 time was higher than the control group[（92.92±3.22）beats/min vs.（89.32±3.22） beats/min], the difference was statistically significant（t=2.34,P〈0.05）.The children of the observation group recovered more slowly than the control group[（20.55±0.97）min vs.（18.62±1.03）min,t=2.17,P〈0.05）],the number of cases of agitation, Aono restless score, anesthesia delirium PAED scores were lower than children in the control group （t=5.38,3.72,2.56,all P〉0.05）.The overall incidence of adverse reactions was similar in the two groups, there was no statistically significant difference （13.33% vs.10.00%,x2=0.12,P〉0.05）.Conclusion Dexmedetomidine given intranasally for the children underwent day surgery can significantly improve the quality of children awakeness, reduce the incidence of postoperative delirium, and without significant side effects.