右美托咪定不同时机给药对学龄前儿童七氟醚麻醉苏醒期躁动的影响

Effects of dexmedetomidine administrated at different time points on emergence agitation following sevoflurane anesthesia in preschool children

目的观察右美托咪定不同时机给药对学龄前儿童七氟醚麻醉苏醒期躁动(EA)的影响。方法将120例接受七氟醚麻醉行扁桃体或腺样体切除术的学龄前(2~7岁)患儿,按随机数字表法分为术前用药组[麻醉诱导前10min开始泵注右美托咪定1μg/(kg·h),持续15min]、术中用药组[诱导插管后5min开始泵注右美托咪定1μg/(kg·h),持续15min]、全程用药组[麻醉诱导前10min至诱导插管后20min持续泵注右美托咪定0.5μg/(kg·h)]、对照组(全程持续泵注等量0.9%氯化钠注射液),每组30例。记录各组患儿麻醉诱导前10min(T0)、诱导插管后20min(T1)、入麻醉恢复室(PACU)后10min(T2)的平均动脉压(MAP)和心率(HR),观察各组手术时间、拔管时间、PACU滞留时间,比较各组术后心动过缓、恶心呕吐、躁动(采用Aono镇静躁动评分)等不良反应发生情况。结果4组患儿围术期各时点(包括T0、T1、T2)MAP、HR、手术时间、PACU滞留时间以及心动过缓、恶心呕吐发生率比较,差异均无统计学意义(均P>0.05);拔管时间、Aono镇静评分和躁动发生率比较,差异均有统计学意义(均P<0.05),其中术中给药组拔管时间较对照组明显延长(P<0.05),而术前、术中、全程用药组间两两比较,差异均无统计学意义(均P>0.05);术前、术中、全程用药组Aono镇静评分及躁动发生率均较对照组明显降低(均P<0.05),全程用药组Aono镇静评分较术中用药组明显降低(P<0.05),而躁动发生率比较差异无统计学意义(P>0.05)。结论右美托咪定不同时机给药均能有效改善学龄前儿童七氟醚麻醉EA,其中全程给药的效果最优,术中给药可延长术后拔管时间。

Objective To investigate the effects of dexmedetomidine administrated at different time points on emergence agitation(EA)following sevoflurane anesthesia in preschool children.Methods One hundred and twenty ASA physical status I or II children aged 2-7 years scheduled for tonsillectomy or adenoidectomy under sevoflurane anesthesia from January 2018 to December 2018,were randomly divided into 4 groups(n=30 for each):the dexmedetomidine[1μg/(kg·h)]was administrated 10 min before anesthesia induction and lasted for 15 min(preoperative medication group),the dexmedetomidine[1μg/(kg·h)]was given 5 min after intubation and lasted for 15 min(intraoperative medication group),the dexmedetomidine[0.5μg/(kg·h)]was given 10 min before anesthesia induction and lasted for 30 min(perioperative medication group),the normal saline was given 10 min before anesthesia induction and lasted for 30 min(control group).The mean arterial pressure(MAP)and heart rate(HR)were recorded 10 min before the induction of anesthesia(T0),20 min after intubation(T1),and 10 min(T2)after entering the recovery room(PACU).The operation time,extubation time,PACU retention time,and occurrence of adverse reactions(bradycardia,nausea and vomiting),and agitation(based on Aono sedation agitation score)were observed in each group.Results There were no significant differences in the general conditions,hemodynamics,PACU retention time,and incidence of bradycardia,nausea,vomiting among 4 groups(P>0.05).The extubation time in intraoperative medication group was significantly longer than that in the control group(P<0.05),but there were no significant differences among all dexmedetomidine groups(P>0.05).Compared with that of the control group,the Aono sedation score and the incidence of agitation in all dexmedetomidine groups were significantly lower(P<0.05).While the Aono sedation score in perioperative medication group was significantly lower than that in intraoperative medication group(P<0.05).Conclusion Dexmedetomidine administrated at different time points can effectively alleviate the emergence agitation(EA)following sevoflurane anesthesia in preschool children,and the perioperative medication is most effective,but intraoperative administration of dexmedetomidine may prolong the postoperative extubation time.