右美托咪定术前滴鼻对腹腔镜手术患儿苏醒期躁动和外周血炎性介质水平的影响

Effects of preoperative nasal drip with dexmedetomidine on the agitation and peripheral blood inflammatory mediators levels in children patients during laparoscopic surgery

目的观察右美托咪定(DEX)术前滴鼻对腹腔镜手术患儿苏醒期躁动和外周血炎症介质水平的影响。方法按随机数表法将2016年7月至2017年12月择期行腹腔镜手术患儿60例分为DEX术前滴鼻组(研究组,n=30)和0.9%氯化钠溶液组(对照组,n=30)。记录手术时间、苏醒时间、麻醉恢复室(PACU)停留时间,记录2组患儿滴鼻前(T1)、滴鼻5 min后(T2)、拔管即刻(T3)、拔管5 min后(T4)、送出PACU时(T5)时血流动力学参数[心率(HR)、平均动脉压(MAP)]、呼吸参数[呼吸频率(RR)、血氧饱和度(SpO2)、呼气末二氧化碳(ETCO2)],于T1、T5时检测2组患儿血清炎症介质[白介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)],比较2组患儿T4时疼痛[东大略儿童医院疼痛评分(CHEOPS)]、躁动[躁动评分(PAED)]情况差异,观察不良反应发生情况。结果 2组手术时间、苏醒时间、PACU停留时间、不良反应发生率差异均无统计学意义(P>0.05)。T1~T5时,2组患儿HR、MAP则于T2、T3时逐步升高,于T4、T5时逐步降低,研究组波动幅度小于对照组,2组上述指标组间效应、时间点效应及组间·时间点交互效应均有显著统计学意义(P<0.05)。T1~T5时,2组RR、SpO2、ETCO2组间效应、时间点效应及组间·时间点交互效应均无统计学意义(P>0.05)。T5时,2组血清IL-6、TNF-α、CRP水平均较T1时上升,且研究组低于对照组(P<0.05)。研究组T4时CHEOPS、PAED评分低于对照组(P<0.05)。结论 DEX术前滴鼻有助于维持腹腔镜手术患儿血流动力学稳定,并可显著减轻其炎症反应和苏醒期躁动情况,对患儿恢复时间、呼吸无明显影响,安全性良好。

Objective To observe the effects of preoperative nasal drip with dexmedetomidine(DEX) on the agitation and peripheral blood inflammatory mediators levels in children patients during laparoscopic surgery.Methods A total of 60 children patients who underwent laparoscopic surgery in our hospital from July 2016 to December 2017 were enrolled in the study,who were divided into DEX preoperative nasal drip group(research group, n=30) and saline group(control group,n=30) according to the random number table method. The operative time, awakening time and the stay time in postanesthesia care unit(PACU) were recorded. Moreover the hemodynamic parameters including heart rate(HR), mean arterial pressure(MAP) and respiratory parameters including respiratory rate(RR), oxygen saturation(SpO2) and end-tidal carbon dioxide(ETCO2) were recorded in both groups before nasal drops(T1), at 5 min after nasal drops(T2), extubation immediately(T3), at 5 min after extubation(T4) and discharging from PACU(T5). In addition the serum inflammatory mediators levels including interleukin-6(IL-6), C-reactive protein(CRP), tumor necrosis factor-α(TNF-α) at T1 and T5 were detected in both groups, and pain scores of Children’s Hospital of Eastern Ontario Pain Scale(CHEOPS) and agitation scores of Pediatric Anesthesia Emergence Delirium(PAED) as well as the incidence of adverse reactions were observed and compared between the two groups.Results There were no significant differences in operative time, recovery time, PACU stay time and incidence rate of adverse reactions between the two groups(P>0.05). The levels of HR and MAP at T2 and T3 were gradually increased in both groups,however,which at T2 and T3 were gradually decreased, and the fluctuation extent in research group was smaller than that in control group, and there were statistically significant differences in above indexes betweenthe two groups(P<0.05).At T1~T5, there were no significant differences in effects betweenthe two groups, time-points effects and interaction effects of between-groups and time-points of RR, SpO2 and ETCO2 between the two groups(P>0.05). At T5, the serum levels of IL-6, TNF-α, and CRP were increased in bth groups,as compared with those at T1,moreover,which in research group were significantly lower than those in control group(P<0.05).In addition the scores of CHEOPS and PAED at T4 in research group were significantly lower than those in control group(P<0.05). Conclusion DEX for preoperative nasal drip helps to maintain hemodynamic stability in children patients undergoing laparoscopic surgery, which can significantly reduce the inflammatory response and agitation,moreover,which has no significant effects on the recovery time and breathing of patients, with good safety.