右美托嘧啶鼻喷超前干预对儿童医源性创伤后应激障碍的影响

Premedication with dexmedetomidine intranasal spray on Iatrogenic post-traumatic stress disorder in children

目的探讨右美托嘧啶（DM）鼻喷超前干预对围术期儿童医源性创伤后应激障碍（PTSD）及远期对儿童人格及智力水平的影响。方法讲120例4～6岁拟行手术治疗儿童随机分为对照组（0．5mL生理盐水喷鼻）和DMl、2、3、4组（分别给予DM0．1、0．2、0．3、0．4μg／kg），每组24例。利用鼻腔无创给药装置滴鼻，待患儿入睡后常规麻醉诱导手术并术后充分常规镇痛。于5组患儿麻醉苏醒后24、48h，出院时，出院后1、3、6个月应用创伤后应激量表（CAPS-Dx）进行评分；于患儿出院后1、3、6个月应用儿童行为量表（CBCL）测评儿童人格有无异常及采用50项智能筛查量表评测智力水平。结果（1）DMl、2、3、4组患儿CAPS-DX、CBCL评分均明显低于对照组，50项智能筛查量表评分均明显高于对照组，差异均有统计学意义（P〈0．05）。（2）DM3组患儿CAPS-DX、CBCL评分均明显低于DMl、2组，50项智能筛查量表评分均明显高于DMl、2组，差异均有统计学意义（P〈0．05）。（3）DM3组患儿cAPS-DX、CBCL评分及50项智能筛查量表评分与DM4组比较差异均无统计学意义（P〉0．05）。结论DM（0．3ug／kg）滴鼻行超前干预安全、有效，可降低医源性应激障碍，并可能改善儿童人格异常及智力水平。

Objective To observe the effect of Dexmedetomidine（DM）premedication by intranasal spray on iatrogenic post-traumatic stress disorder（PTSD） and late personality and intelligence level in children. Methods 120 children,ASA Ⅰ or Ⅱ ,age of 4-6 years old, selected for surgery, were randomly divided into 5 groups（n=24,each）. The control group（C） was administrated with 0.5 mL saline,group DM1 was given DM1 0.1 μg/kg,DM2 with 0.2 μg/kg,DM3 with 0.3 μg/kg and DM4 with 0.4 μg/kg,respectively. All infants were given DM spray nasally by using a noninvasive delivery device according to the planned nasal drops. 10-15 min lat- er, the patients were fall into asleep,then start the induction of anesthesia and performed the surgery. After operation 24,48 h and discharge,PTSD Scale was assessed by CAPS-DX（Clinician Administered For diagnosis manual statistics）. After the infants were discharged at 1,3,and 6 month,CAPS-DX score,behavior scale with CBCL and the intelligence level with 50 intelligence screening scale were recorded, respectively. Results CAPS-DX and CBCL score in group DMs were significantly lower compare with group C （P〈0.05）. 50 intelligence screening scale scores were significantly increased（P〈0.05）. CAPS-DX and CBCL in group DM3 were significantly lower compared with group DM1 and DM2 （P〈0.05）. There was not significantly different of CAPS-DX, CBCL score and 50 intelligence screening scale scores between group DM4 and DM3（P〈0.05）. Conclusion Premedication with DM（0.3μg/ kg） spraying in tranasally is safe and feasible, which can reduce the iatrogenie PTSD and improve abnormal levels of intelligence and personality in children.