不同剂量右美托咪定术后滴鼻对小儿扁桃体腺样体切除术患者血流动力学及咽痛的影响

Effect of different doses of dexmedetomidine on hemodynamics and postoperative sore throat in children undergoing tonsil adenoidectomy

目的评价不同剂量右美托咪定术后滴鼻对小儿扁桃体腺样体低温等离子切除术患者咽痛以及血流动力学的影响。方法纳入2018年12月-2019年10月在南京医科大学附属淮安第一医院耳鼻喉头颈外科接受扁桃体腺样体低温等离子切除术的6~10岁患儿100例,分为4组,在术毕清醒拔管2 min后,分别经双侧鼻腔滴入不同剂量右美托咪定:0.5μg/kg(D1组,n=25)、1.0μg/kg(D2组,n=25)、1.5μg/kg(D3组,n=25)和0.9%氯化钠注射液1 ml(C组,n=25)]。记录鼻腔滴药时(T1)、滴药后15 min(T2)、30 min(T3)、60 min(T4)患儿心率、血压、脉搏氧饱和度及手术结束后6 h(T6)、24 h(T7)、48 h(T8)及72 h(T9)患儿静息时和做吞咽动作时咽部疼痛程度。结果不同剂量的右美托咪定对平均动脉压、血氧饱和度的影响差异无统计学意义(P>0.05),但D3组1.5μg/kg右美托咪定0.9%氯化钠注射液可显著降低患者心率(P<0.05)。不同剂量的右美托咪定作用下,静息状态咽痛程度均随着治疗时间呈现先上升,后下降的变化趋势,与0.9%氯化钠注射液组差异无统计学意义(P均>0.05)。不同剂量的右美托咪定对做吞咽动作时咽部疼痛程度具有一定的改善,T7、T8时间点,D2组及D3组VAS评分均低于D1组及C组(P<0.05),D2组与D3组无统计学差异(P>0.05),说明两剂量对于吞咽动作时咽部疼痛缓解效果相似,且缓解效果均优于0.9%氯化钠注射液组和D1组。结论1.0μg/kg右美托咪定0.9%氯化钠注射液能明显改善扁桃体腺样体低温等离子切除患儿术后咽部疼痛,且具有较好的血流动力学安全性。

Objective To evaluate the effect of different doses of dexmedetomidine nasal drip on the hemodynamics and postoperative sore throat in children undergoing pediatric tonsillar adenoid hypothermia plasma resection.Methods From December 2018 to October 2019,a total of 100 children aged 6-10 years who underwent tonsillar adenoid hypothermia plasma resection in the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University were included and divided into four groups.Two minutes after surgery and extubation,different doses of dexmedetomidine([0.5μg/kg[D1 Group,n=25],1.0μg/kg[Group D2,n=25],1.5μg/kg[Group D3,n=25]and 1ml of saline[Group C,n=25])were dripped through both sides of the nasal cavity.The heart rate,blood pressure and pulse oxygen saturation were recorded when the drug was dripped immediately(T1),and at 15 min(T2),30 min(T3)and 60 min(T4),and the degree of throat pain during rest and swallowing at 6 hours(T6),24 hours(T7),48 hours(T8),and 72 hours(T9)after the operation were also recorded.Results The effects of different doses of dexmedetomidine on mean arterial pressure and oxygen saturation were not statistically different between the four groups(P>0.05).Saline solution with 1.5μg/kg dexmedetomidine(D3 group)significantly reduced the heart rate of patients compared to the other 3 groups(P<0.05).Under the effect of different doses of dexmedetomidine,the degree of sore throat in resting state increased first and then decreased over time,without significant difference when compared with normal saline group(all P>0.05).At T7 and T8,the improvement of throat pain when swallowing in D2 and D3 groups were significantly higher than those of D1 and C groups(P<0.05),while there was no significant difference between the D2 group and D3 group(P>0.05),which suggested that the two doses had similar effects on alleviating pharyngealpain during swallowing,and the alleviating effects were better than those in the saline group and the D1 group.Conclusion Salinesolution with 1.0μg/kg dexmede-tomidine can significantly improve postoperative pharyngeal pain in children with tonsil adenoidhypothermia plasma resection,with satisfactory hemodynamic safety.