不同剂量右美托咪定滴鼻用于小儿术前镇静效果比较

Comparison of sedative effects of different intranasal dexmedetomidine doses for premedication in children

目的比较术前使用不同剂量的右美托咪定(dexmedetomidine,Dex)滴鼻用于扁桃体腺样体切除术患儿的镇静效果。方法择期行扁桃体腺样体切除术的患儿192例,按随机数字表法分为Dex 2μg/kg组(A组)、Dex 3μg/kg组(B组)和Dex 4μg/kg组(C组),每组64例。在手术等候区给予患儿相应剂量的Dex滴鼻,评估患儿的镇静情况,镇静满意后转运至手术室。记录3组的镇静起效时间、苏醒时间、Dex滴鼻前后和苏醒前后患儿的心率和SpO2,计算患儿的分离情绪满意率、静脉穿刺满意率、苏醒后躁动和疼痛发生率以及不良反应发生情况。结果与A组比较,B组和C组患儿镇静起效时间明显缩短(P<0.05)。C组患儿的术后苏醒时间显著长于A组和B组(P<0.05)。Dex滴鼻后,3组患儿的SpO2均出现下降(P<0.05),C组心率也明显下降(P<0.05);C组患儿在给药后各时间点的心率和SpO2与A组和B组比较,差异有统计学意义(P<0.05)。3组患儿的分离情绪满意率均可达90%,差异无统计学意义(P>0.05)。B组和C组患儿静脉穿刺满意率高于A组,但差异无统计学意义(P>0.05)。3组患儿苏醒后躁动和疼痛发生率均较低,差异无统计学意义(P>0.05)。C组有3例患儿在麻醉诱导后出现心动过缓,予以0.01 mg/kg阿托品后缓解,围手术期未再发生。结论扁桃体腺样体切除术患儿术前使用3μg/kg Dex滴鼻,镇静起效较快,对呼吸循环影响小,患儿的分离情绪满意率和静脉穿刺满意率高,对术后苏醒影响小。

Objective This study was designed to compare the sedative effects of three intranasal dexmedetomidine(Dex)doses for premedication in children undergoing adenotonsillectomy.Methods One hundred and ninety‑two children undergoing elective adenotonsil‑lectomy were randomly divided into Dex 2µg/kg group(group A),Dex 3µg/kg group(group B)and Dex 4µg/kg group(group C),n=64 each.After entering the operation waiting area,the children in different groups received intranasal Dex 2,3µg/kg or 4µg/kg respectively,the sedation status was assessed after administration.Once the children achieved satisfactory sedation state,they were transferred to the operating room for an‑esthesia and surgery.Researchers recorded onset time of sedation,recovery time and vital signs of children before and after administration and recovery.Then they calculated the emotional satisfaction rate of kids when they were separated with parents,the satisfaction rate of venipuncture after admission,the incidence of agitation and pain after awaking and postoperative adverse reactions.Results Compared with group A,the onset time of sedation was significantly shortened in group B and group C,the difference was statistically significant(P<0.05).Compared with group A and group B,the postoperative recovery time of group C was significantly prolonged(P<0.05).After administration,the pulse oxygen sat‑uration(SpO2)and heart rate in the three groups was declined(P<0.05),the heart rate was declined in group C(P<0.05).The heart rate and SpO2 in group C were statistically lower than the values in group A and group B at each time point(P<0.05).The emotional satisfaction rate at separat‑ing time of the kids in the three groups were all over 90%,there was no significant difference between the three groups(P>0.05).The satisfac‑tion rates of venipuncture in group B and group C were higher than that in group A,but the difference was not statistically significant(P>0.05).The incidences of agitation and pain in the three groups were lower than the incidences after awakening,but the differences were not statistically significant(P>0.05).In group C,bradycardia occurred in 3 children after anesthesia induction and were relieved after given 0.01 mg/kg of atropine;which did not happen again during the operation.Conclusions Intranasal Dex 3µg/kg before adenotonsillectomy can effec‑tively alleviate preoperative anxiety and have a quicker onset time of sedation.The satisfaction rates of children's separating emotion and ve‑nipuncture are high.At the same time,it has less effect on children's vital signs and the recovery time and quality.