右美托咪定滴鼻给药在两种类型先天性心脏病患儿术前镇静方面的临床应用研究

Clinical Application of Dexmedetomidine Nasal Drops in Preoperative Sedation for Children with Two Different Types of Congenital Heart Disease

目的:探讨右美托咪定滴鼻给药在紫绀型和非紫绀型先天性心脏病患儿术前镇静的应用价值。方法:选取2017年6月至2018年12月四川绵阳四〇四医院收治的先天性心脏病患儿80例,其中紫绀型40例,非紫绀型40例,两种类型患儿分别采用随机数字表法分为对照组(0.9%氯化钠注射液)、低剂量组(右美托咪定1μg/kg)、中剂量组(右美托咪定2μg/kg)及高剂量组(右美托咪定3μg/kg),每组10例。评估患儿拉姆赛评分(Ramsey score,Ramsay)和改良耶鲁围术期焦虑量表(Modified Yale perioperative anxiety scale,mYPAS)评分,检测心率(HR)、血氧饱和度(SpO2)水平。结果:紫绀型、非紫绀型低、中及高剂量组患儿Ramsay评分明显高于对照组,mYPAS评分明显低于对照组;紫绀型、非紫绀型高剂量组患儿Ramsay评分明显高于低、中剂量组,mYPAS评分明显低于低、中剂量组,上述差异均有统计学意义(P<0.05)。给药前、给药后10、20和30 min,紫绀型四组患儿HR、SPO2水平的差异均无统计学意义(P>0.05);非紫绀型四组患儿HR、SPO2水平的差异均无统计学意义(P>0.05)。结论:右美托咪定滴鼻给药用于先天性心脏病患儿术前镇静的效果较好,在紫绀型和非紫绀型先天性心脏病患儿中应用的效果相近。

OBJECTIVE:To probe into the application value of dexmedetomidine(DEX)nasal drops in preoperative sedation for children with cyanotic and non-cyanotic congenital heart disease.METHODS:Totally 80 children with congenital heart disease admitted into Sichuan Mianyang 404 Hospital from Jun.2017 to Dec.2018 were extracted,including 40 cases of cyanotic heart disease and 40 cases of non-cyanotic congenital heart disease.All children were divided into the control group(0.9%sodium chloride solution),low-dose group(DEX 1μg/kg),medium-dose group(DEX 2μg/kg)and high-dose group(DEX 3μg/kg)via the random number table,with 10 cases in each group.Ramsey score(Ramsay)and Modified Yale perioperative anxiety scale(mYPAS)of two groups were evaluated.Heart rate(HR)and oxygen saturation(SpO2)were measured.RESULTS:The Ramsay score of cyanotic and non-cyanotic children in the low-dose,medium-dose and high-dose group was significantly higher than that of the control group,and the mYPAS score was significantly lower than that of the control group.Among them,the Ramsay score of cyanotic and non-cyanotic children in the high-dose group was significantly higher than that of low-dose and medium-dose group and mYPAS score was significantly lower than that of low-dose and medium-dose group,the differences were statistically significant(P<0.05).Before administration and after administration of 10,20 and 30 min,there was no statistically significant difference in the levels of HR and SpO2 among four groups of children with cyanotic heart disease(P>0.05),and the difference in the levels of HR and SpO2 among four groups of children with non-cyanotic heart disease was not statistically significant(P>0.05).CONCLUSIONS:The application of DEX nasal drops is effective in preoperative sedation of children with congenital heart disease and had similar effects in cyanotic and non-cyanotic congenital heart disease.