术前喷鼻右旋美托咪定和咪达唑仑对腭裂患儿术前镇静和术后躁动的影响

Comparison of Intranasal Dexmedetomidine and Midazolam on Preoperative Sedation and Postoperative Agitation in Pediatrics with Cleft Palate Surgery

目的:比较采用喷鼻给药方式,将右旋美托咪定和咪达唑仑作为术前用药,对腭裂患儿术前镇静及预防苏醒期躁动的效果。方法:择期全麻下行腭裂手术的患儿60例,随机分为3组:咪达唑仑组(MID组)、右旋美托咪定组(DEX组)和生理盐水组(NS组)。麻醉前45 min对3组患儿采用喷鼻方式使用不同镇静药物。每种药物按每kg体质量用药的剂量如下:MID组为0.4 mg/kg,DEX组为3μg/kg,NS组为与DEX组等容积的0.9%NaCl溶液。分析患儿喷鼻前焦虑评分、入室前焦虑评分、苏醒期疼痛评分、苏醒期躁动评分及不良反应发生情况。结果:DEX组和MID组患儿入室前焦虑评分明显低于NS组(P<0.05),DEX组患儿苏醒期躁动评分显著低于MID组和NS组(P<0.05),3组患儿术后疼痛评分差异无统计学意义(P>0.05)。结论:喷鼻咪达唑仑和右旋美托咪定均可作为小儿的术前镇静用药,而喷鼻右旋美托咪定能有效降低小儿苏醒期躁动的发生。

Objective:To compare the effects of intranasal dexmedetomidine and intranasal midazolam on preoperative sedation and anesthesia agitation among children who underwent cleft palate surgery.Methods:Sixty children,who underwent cleft palate surgery,were randomly divided into group MID(intranasal midazolam 0.4 mg/kg),group DEX(intranasal dexmedetomidine 3μg/kg),and group NS(intranasal normal saline).Anesthesia was induced 45 min after giving the intranasal sedatives and maintained with sevoflurane.Psychological condition of patients were estimated by the Modified Yale Preoperative Anxiety Scale(m-YPAS)before premedication and at 45 min after premedication.The incidence of analgesia(FLACC scale),the anesthesia agitation score and adverse events were also recorded.Results:The m-YPAS scores at 45 min after premedication in group DEX and MID were significant lower than that in group NS(P<0.05).The anesthesia agitation scores were significant lower in the group DEX(P<0.05).No significant difference were found in analgesia score among all groups(P>0.05).Conclusion:Intranasal dexmedetomidine and midazolam provided satisfactory sedation levels.Moreover,premedicated with intranasal dexmedetomidine decreased the occurence of anesthesia agitation.