右美托咪定喷鼻对全麻患儿神经认知恢复延迟的影响

Effects of dexmedetomidine nasal spray on delayed neurocognitive recovery in children under general anesthesia

目的观察术前经鼻腔喷雾右美托咪定对全麻患儿神经认知功能恢复延迟发生率和其血清S100β含量和IL-6浓度的影响。方法选择择期在全麻下行扁桃体腺样体切除术的患儿70例,男42例,女28例,年龄6~8岁,ASAⅠ或Ⅱ级。采用随机数字表法分为右美托咪定组(D组)和对照组(C组),每组35例。在麻醉诱导前30 min使用鼻腔喷雾装置,D组给予右美托咪定2.0μg/kg,C组给予0.02 ml/kg的生理盐水。评估患儿拔管后30 min时镇静评分(Ramsay评分)和改良加拿大东安大略儿童医院疼痛评分(m-CHEOPS评分),当m-CHEOPS评分>5分时,给予芬太尼0.5μg/kg补救镇痛,记录术后芬太尼使用情况。分别于术前1 d、术后1、3和30 d记录两组患儿简易智力状态检查量表(MMSE)评分,并于术前1 d、术后1和3 d采集外周静脉血,检测血清S100β含量和IL-6浓度。记录术后恶心呕吐、喉痉挛、低血压、呼吸抑制和心动过缓等不良反应发生情况。结果与C组比较,D组术后Ramsay镇静评分明显升高(P<0.05),m-CHEOPS评分明显降低(P<0.05),芬太尼使用明显减少(P<0.05)。与术前1 d比较,术后1和3 d两组MMSE评分明显降低(P<0.05)。术后1和3 d,D组MMSE评分明显高于C组(P<0.05),D组神经认知功能恢复延迟发生率明显低于C组(P<0.05)。与术前1 d比较,术后1和3 d两组血清S100β含量和IL-6浓度明显升高(P<0.05)。术后1和3 d,D组血清S100β含量和IL-6浓度明显低于C组(P<0.05)。两组恶心呕吐、喉痉挛、低血压、呼吸抑制和心动过缓等不良反应发生情况差异无统计学意义。结论麻醉诱导前30 min经鼻喷雾右美托咪定2.0μg/kg,可有效抑制血清中S100β含量和IL-6浓度的升高,减少全麻患儿神经认知恢复延迟的发生。

Objective To evaluate the effect of dexmedetomidine nasal spray on the incidence of delayed neurocognitive recovery(DNR)and the levels of serum S100β and IL-6 in pediatric surgrey under general anesthesia. Methods Seventy children, 42 boys and 28 girls, aged 6-8 years, falling into ASA physical status Ⅰ or Ⅱ, about to undergo adenoidectomy andtonsillectomy under general anesthesia, were enrolled and randomly divided into two groups: dexmedetomidine group(group D) and control group(group C),with 35 cases in each group. A nasal spray device was used 30 minutes before induction of anesthesia, with 2.0 μg/kg atomized dexmedetomidine administrated intranasally in group D and 0.02 ml/kg atomized saline administrated in group C. The Ramsay sedation score and the modified Children′s Hospital of Eastern Ontario Pain Scale(m-CHEOPS) score were assessed at 30 min after extubation. When m-CHEOPS was greater than 5, a dosage of 0.5 μg/kg of fentanyl was administrated to remedy analgesia, and the cumulative consumption of fentanyl was recorded. The Mini-Mental State Examination(MMSE) scores of two groups were recorded at 1 day before and 1, 3 and 30 days after surgery. Peripheral venous blood was collected and the levels of S100β and IL-6 in serum were detected on the 1^st preoperative day and the 1^st and 3rd postoperative day. The incidence of adverse reactions such as postoperative nausea and vomiting, laryngospasm, hypotension, respiratory obstruction and bradycardia were recorded. Results In group D, the Ramsay sedation score was significantly higher than that in group C, while the m-CHEOPS pain score and the cumulative consumption of additional fentanyl reduced remarkably compared with group C(P<0.05). The MMSE scores of the children on the 1^st and 3rd postoperative day were significantly lower than that on the 1^st preoperative day(P<0.05). On the 1^st and 3rdpostoperative day, the MMSE score of group D was significantly higher than that of group C(P<0.05), while the incidence of DNR reduced notably(P<0.05). Compared with the 1^st preoperative day, the levels of serum S100β and IL-6 in two groups increased significantly on the 1^st and 3rd postoperative day(P<0.05), at which time the levels of serum S100β and IL-6 in group D were significantly lower than that in group C(P<0.05). No significant difference were seen between the two groups in the incidence of adverse reactions such as postoperative nausea and vomiting, laryngospasm, hypotension, respiratory obstruction and bradycardia. Conclusion Nasal spray of 2.0 μg/kg atomized dexmedetomidine 30 minutes before induction of anesthesia could effectively inhibit the increase of serum S100β and IL-6 concentration and reduce the incidence of delayed neurocognitive recovery in children under general anesthesia.