术前右美托咪定经鼻雾化对全麻眼睑手术患儿术后不良行为改变的影响

The effects of different doses of dexmedetomidine by nasal atomization on negative postoperative behavioural changes of children undergoing eyelid surgery under general anesthesia

目的 观察术前不同剂量右美托咪定经鼻雾化用药对全麻眼睑手术患儿术后不良行为改变的影响.方法 选择择期在全麻下行眼睑手术的患儿192例,男89例,女103例,年龄3~7岁,体重12~40 kg,ASA分级Ⅰ—Ⅱ级.采用随机数字表法分成4组,每组48例.试验组即D1、D2、D3组在父母陪伴下进入诱导室,分别予右美托咪定1、2、3μg/kg经鼻雾化,对照组(C组)予生理盐水0.02 ml/kg经鼻雾化.记录患儿术前镇静评分、与父母分离情绪评分、面罩接受度评分、患儿在麻醉恢复室期间发生躁动例数、躁动评分;记录拔管及苏醒时间、围术期不良事件(心动过缓、喉痉挛).术后1、7、30 d采用术后行为量表(PHBQ)评估患儿术后及出院后的行为情况.结果 与C组比较,D1、D2、D3组患儿术后1 d不良行为改变发生率明显降低(P<0.05);与C组比较,D2、D3组术后7 d不良行为改变发生率明显降低(P<0.05);术后1、7 d,D组分离焦虑、睡眠焦虑的发生率明显低于C组(P<0.05);其他行为改变发生率的差异无统计学意义(P>0.05).与C组比较,D1、D2、D3组患儿Ramsay镇静评分、与父母分离情绪评分、面罩接受度评分明显升高,术后躁动评分明显降低(P<0.05);D3组患儿苏醒时间较其余3组明显延长(P<0.05).4组患儿拔管时间及心动过缓、喉痉挛发生率的差异无统计学意义(P>0.05).结论 术前2μg/kg右美托咪定经鼻雾化用药可有效降低全麻患儿术后不良行为改变发生率.

Objective To observe the effects of different doses of dexmedetomidine by nasal atomization on negative postoperative behavioural changes of children undergoing eyelid surgery under general anesthesia.Methods A total of 192 children(89 males and 103 females,aged 3-7 years,weighing 12-40 kg,ASA gradeⅠ-Ⅱ)underwent eyelid surgery under general anesthesia were enrolled in this study and were equally assigned into four groups(n=48 in each group)using a random number table method:a control group(group C),a dexmedetomidine 1μg/kg group(group D 1),a dexmedetomidine 2μg/kg group(group D 2)and a dexmedetomidine 3μg/kg group(group D 3).The experimental groups(groups D 1,D 2 and D 3)received different doses of dexmedetomidine(1,2 or 3μg/kg,respectively)nasal atomization in the induction room accompanied by their parents,and the control group(Group C)received 0.02 ml/kg normal saline nasal atomization.The preoperative sedation score,emotion score due to separation from parents,mask acceptance score,the number of cases of restlessness in the post-anesthesia care unit(PACU),agitation score,extubation and recovery time,and perioperative adverse events(bradycardia,laryngospasm)were recorded.The Post Hospitalization Behavior Questionnaire(PHBQ)was used to evaluate the behavior of the children after operation and discharge at 1,7 and 30 d after operation.Results Compared with group C,the incidence of adverse behavior changes was significantly lower in groups D 1,D 2 and D 3 at 1 d after surgery(P<0.05).Compared with group C,the incidence of adverse behavior changes at 7 d after operation in groups D 2 and D 3 was significantly reduced(P<0.05).At 1 and 7 d after surgery,the incidence of separation anxiety and sleep anxiety in group Ds was significantly lower than that in group C(P<0.05).There was no statistically significant difference in the incidence of other behavioral changes among the 4 groups(P>0.05).Compared with group C,Ramsay Sedation Score,separation emotion score and mask acceptance score of children in groups D 1,D 2 and D 3 were significantly increased,while postoperative agitation score was significantly decreased(P<0.05).The wake-up time of children in group D 3 was significantly longer than that of the other 3 groups(P<0.05).There was no significant difference in extubation time,bradycardia and laryngospasm among the 4 groups(P>0.05).Conclusions Preoperative 2μg/kg dexmedetomidine by nasal atomization can effectively reduce the incidence of postoperative adverse behavior changes in children under general anesthesia.