经鼻滴注右美托咪定联合心理干预对七氟烷麻醉下小儿术前焦虑及苏醒期躁动的影响

Effects of intranasal dexmedetomidine combined psychological intervention on preoperative anxiety and emergence agitation in children with sevoflurane anesthesia

目的观察不同剂量右美托咪定(dexmedetomidine,Dex)单独或联合心理干预措施对七氟烷麻醉下小儿术前焦虑及苏醒期躁动的影响。方法选择择期行小儿眼科短小手术的患儿60例,年龄2~6岁,随机分为A组(单纯Dex 1μg/kg滴鼻)、B组(单纯Dex 2μg/kg滴鼻)、C组(Dex 1μg/kg滴鼻+心理干预)、D组(Dex 2μg/kg滴鼻+心理干预),每组15例。采用七氟烷吸入诱导和维持麻醉,置入喉罩辅助通气。所有患儿均在术前等候区经鼻滴注盐酸右美托咪定,同时为C、D组患儿提供手机观看动画片或手持玩具。分别于滴鼻前、进入手术室前和诱导前采用改良耶鲁围术期焦虑量表(modified Yale perioperative anxiety scale,m YPAS)评估患儿的焦虑水平。记录术前m YPAS量表评分、术后躁动评分,围术期平均动脉压、心率、脉搏血氧饱和度,手术时间、麻醉时间、苏醒时间,记录术后呕吐、呛咳、呼吸抑制等不良反应。结果 4组患儿手术时间、麻醉时间、苏醒时间比较差异均无统计学意义(P>0.05);4组m YPAS量表评分均较滴鼻前降低(P<0.05),但诱导前评分升高(P<0.05)。组间m YPAS量表评分比较,B、D组分别低于A、C组(P<0.05),C、D组分别低于A、B组(P<0.05)。D组发生躁动例数少于A组(P<0.05),D组躁动评分低于其他3组(P<0.05)。4组患儿均未观察到术后呕吐、呛咳、呼吸抑制等不良反应。家长满意度评分组间比较差异无统计学意义(P>0.05)。结论患儿入室前经鼻滴注盐酸右美托咪定可减少小儿术前焦虑评分及术后躁动评分,2μg/kg Dex较1μg/kg Dex效果更好,联合应用心理干预效果最佳。

Objective To investigate the effects of different doses of intranasal dexmedetomidine （Dex） alone or combined with psychological intervention on preoperative anxiety and emergence agitation in children with sevoflurane anesthesia. Methods Sixty of 2-6 years old children undergoing ophthalmologic minor surgery were randomly divided into four groups： Group A （Dex 1 μg/kg）, Group B （Dex 2 μg/kg）, Group C （Dex 1 μg/kg ＋ psychological intervention）, Group D （Dex 2 μg/kg ＋ psychological intervention）. All patients received intranasal Dex 1 μg/kg or 2 μg/kg respectively in the waiting area. And the patients in group C and group D were provided with mobile phone to watch cartoons or handheld toys. Sevoflurane inhalation was used to induce and maintain anesthesia, and laryngeal mask was placed to assist ventilation. The anxiety level was evaluated by modified Yale perioperative anxiety scale （mYPAS） at the time before nasal drip, before entering operating room and before induction. The scores of preoperative mYPAS scale, emergence agi- tation score, perioperative MAP, HR and SpO2, length of operation, duration of anesthesia, times to recovery, postoperative vomiting, cough and respiratory depression were recorded. Results There was no significant difference in the length of operation, duration of anesthesia, times to recovery, among the four groups （P 〉 0.05）, The scores of mYPAS scale in the four groups were lower than those before nasal drip （P 〈 0.05）, but the scores increased before induction （P 〈 0.05）. The scores of mYPAS scale in group B and group D were lower than those in group A and group C respectively （P 〈 0.05）, the scores of mYPAS scale in group C and group D were lower than those in group A and group B respectively （P 〈 0.05）. The number of emergence agitation in group D was lower than that in group A （P 〈 0.05） and the score of emergence agitation in group D was lower than those in other groups （P 〈 0.05）. No adverse effects such as vomiting, cough and respiratory depression was observed in four groups. There was no significant difference in parental satisfaction score among four groups （P 〉 0.05）. Conclusion Intranasal Dex before entering operation room can reduce preoperative anxi- ety score and emergence agitation score. The effect of Dex 2μg/kg was better than Dex 1μg/kg. Dex 2 μg/kg combined with psychological intervention is the best.