不同剂量右美托咪定滴鼻对扁桃体摘除术患儿血流动力学及术后行为的影响

Effect of Intranasal Administration of Different Doses of Dexmedetomidine on Hemodynamics and Postoperative Behaviors of Children Undergoing Tonsillectomy

目的:探讨不同剂量的右美托咪定滴鼻对扁桃体摘除术患儿血流动力学及术后行为的影响。方法:搜集我院2014年7月至2017年10月216例择期行扁桃体摘除术患儿为研究对象,根据采用右美托咪定滴鼻剂量分为低剂量组与高剂量组,观察两组患儿用药后血流动力学变化,并记录拔管时间、出麻醉恢复室时间,术前镇静程度采用警觉-镇静(OAAS评分),采用苏醒期躁动量化评分表(PEAD)评估患儿术后行为,加拿大安大略儿童医院疼痛评分量表(m-CHEOPS)进行疼痛评分,统计围手术期间患儿的不良反应。结果:两组MAP、HR随着手术的进展呈先降后升趋势,Sp O2较为平稳;术后各个时间点,低剂量组的MAP、HR与T0时刻均有显著性差异(P <0. 05),Sp O2均无显著差异(P> 0. 05);术后各个时间点,高剂量组的MAP与T0时刻均有显著性差异(P <0. 05),T3、T4、T5时刻,HR与T0时刻均有显著性差异(P <0. 05),Sp O2均无显著差异(P> 0. 05);且高剂量组MAP、HR波动幅度显著低于低剂量组(P <0. 05)。高剂量组术前镇静程度OAAS评分(3. 2±0. 6)分,均显著低于低剂量组(3. 8±0. 7)分(P <0. 05),但两组拔管时间、出麻醉恢复室时间均无显著差异(P> 0. 05);低剂量组PEAD评分为(13. 7±4. 3)分,m-CHEOPS评分(4. 5±0. 8)分,均显著高于高剂量组(12. 4±4. 3)分、(3. 4±4. 3)分(P <0. 05)。低剂量组不良反应总发生率17. 6%,与高剂量组16. 7%比较均无显著差异(P> 0. 05)。结论:高剂量右美托咪定滴鼻有利于维持扁桃体切除患儿围手术血流动力学稳定,避免术后躁动。

Objective：To investigate the effect of intranasal administration of different doses of dexmedetomidin on hemodynamics and postoperative behaviors of children undergoing tonsillectomy. Methods ： 216 children undergoing tonsillectomy in the hospital were selected as the subjects. According to the dose of dexmedetomidine, they were divided into low-dose group and high-dose group. The hemodynamie changes in the two groups were observed after medication. The extubation time and the time of recovery from anesthesia were recorded. The degree of preoperative sedation, postoperative behaviors of children and pain were evaluated with the the Observer＇s Assessment of Alertness/Sedation Scale（ OAAS score）, the Pediatric Anesthesia Emergence Delirium（PEAD） and the modified Children＇s Hospital of Eastemontario Pain Scale （m-CHEOPS）, respectively. Adverse reactions during the perioperative period were statistically analyzed. Results ： The MAP and HR of the two groups decreased firstly and then increased with the progress of the operation, and the SpO2 was relatively stable. Compared with To , there were significant differences in MAP and HR of the low-dose group at the other time points after operation（ P 〈 0. 05 ）, but there was no significant difference in SpO2 （P 〉 0. 05 ）. Compared with To, there were significant differences in MAP of high-dose group at the other time points after operation and in HR at T3 , T4 and T5 （ P 〈 0. 05 ） , but there was no significant difference in SpO2 （ P 〉 0. 05 ）. The fluctuation ranges of MAP and HR in the high-dose group were significantly smaller than those in the low-dose group（P 〈 0. 05）. The preoperative OAAS score of the high-dose group was significantly lower than that of the low-dose group [ （3.2 ±0. 6） vs（3.8 ±0. 7） ] （P 〈0. 05）, but there was no significant difference in extubation time or recovery time between two groups （P 〉 0. 05）. The PEAD score and m-CHEOPS score of the low-dose group were significantly higher than those of the high-dose group [（13.7±4.3） and（4.5 ±0.8） vs. （12.4 ±4.3） and（3.4 ±4.3）] （P 〈0.05）. There was no significant difference in the total incidence of adverse reactions between the two groups （ 17. 6% vs 16. 7% ） （ P 〉 0. 05 ）. Conclusion： The intranasal administration of high-dose dexmedetomidine is helpful to maintain the hemodynamic stability and avoid postoperative agitation in children undergoing tonsillectomy.