右美托咪定滴鼻在小儿扁桃体摘除术中的临床观察

Clinical observision of intranasal dexmedetomidine in pediatric tonsillectomy

目的:观察右美托咪定滴鼻在小儿扁桃体摘除术中应用的临床效果。方法:择期行扁桃体摘除术患儿30例,随机分为右美托咪定1.0μg·kg^(-1)组(D组)和生理盐水组(NS组),每组15例,分别在麻醉诱导前30 min右美托咪定1μg·kg^(-1)或等量生理盐水滴鼻,记录患儿开放静脉通路时、与父母分离时镇静评分,拔管时躁动评分,恢复室5 min躁动评分。记录滴鼻前(T0,基础状态)、滴鼻后30 min(T1)、诱导插管时(T2)、拔管时(T3)、拔管后5 min(T4)心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、脉搏氧饱和度(Sp O2)及两组患儿拔管时间。结果:D组患儿T1~T4时HR低于T0(P<0.05),NS组T2、T3时HR高于T0(P<0.05)。D组T1~T4时患儿HR较NS组低,差异具有统计学意义(P<0.05)。两组患儿与父母分离时镇静评分、拔管时躁动评分、恢复室5 min躁动评分差异具有统计学意义(P<0.05)。结论:右美托咪定1.0μg·kg^(-1)术前滴鼻可安全有效地用于小儿扁桃体摘除术,术前提供良好镇静,术后预防苏醒期躁动。

Objective： To observe the clinical effects of intranasal dexmedetomidine in pediatric tonsillectomy.Methods： Thirty children undergoing tonsillectomy were randomly divided into dexmedetomidine 1. 0 μg · kg^-1 group（ D group） and normal saline group（ NS group）. They received intranasal dexmedetomidine 1. 0 μg·kg^-1 or normal saline 30 munites before anesthesia induction. The sedation score of placement of Ⅳ cannula and parental separation were recorded,the agitation score at tracheal extubation and at five minutes after PACU were recorded too. The changes of HR,MAP,RR,Sp O2 were recorded before intranasal administration（ T0,baseline）,30 minutes after intranasal administration（ T1）,at the time of intubation（ T2）,at the time of extubation（ T3） and 5 minutes after extubation（ T4）. Results： The HR in group D at T1-T4 were lower than those at T0. The HR in group NS at T2,T3 were higher than those at T0. The HR in group D were lower than those in group NS at T1-T4,and there were statistically significant（ P〈0. 05）. The sedation score at parental separation,the agitation score at tracheal extubation and at five minutes after PACU were different between the two groups,and there were statistically significant（ P〈0. 05） Conclusion： Intranasal dexmedetomidine before anesthesia induction may provide a safe and good sedation effect for chidren undergoing tonsillectomy,and can prevent emergence agitation.