不同剂量右美托咪定鼻腔给药用于小儿疝气手术中的临床研究

Different doses of dexmedetomidineby nasal dripping in surgery for pediatric hernia

目的探讨不同剂量右美托咪定(DEX)鼻腔给药在小儿疝气手术中的有效性及安全性。方法选择本院2014年1月至2019年8月择期疝气手术的90例患儿作为研究对象,随机分为对照组、低剂量组、高剂量组3组各30例。术前对照组滴鼻生理盐水,低剂量组DEX滴鼻1.0μg/kg,高剂量组DEX滴鼻2.0μg/kg。比较3组患儿的麻醉时间、手术时间、苏醒时间、拔管时间,计算麻醉诱导及麻醉维持中麻醉药瑞芬太尼和丙泊酚的总用量;记录DEX滴鼻前、滴鼻后10、20、30 min的心率、血氧饱和度;采用躁动评分法评价患儿苏醒即刻、苏醒后15、30、60 min的躁动情况。结果3组患儿麻醉时间、手术时间、苏醒时间、拔管时间比较,差异无统计学意义(P>0.05);对照组的瑞芬太尼和丙泊酚用量明显大于其他两组,且高剂量组丙泊酚用量明显少于低剂量组,差异有统计学意义(P<0.01)。所有患儿在各个时点心率比较差异无统计学意义(P>0.05);血氧饱和度与DEX滴鼻前比较,低剂量组滴鼻后30 min时点下降,高剂量组滴鼻后20 min和30 min时点下降,差异有统计学意义(P<0.05或P<0.01);各组在滴鼻后30 min时点血氧饱和度明显低于对照组,差异有统计学意义(P<0.01)。高剂量组各时点苏醒躁动评分明显低于对照组,差异有统计学意义(P<0.01)。结论2.0μg/kg DEX滴鼻预处理可以显著减少小儿疝气术中其他静脉麻醉药物的用量和苏醒期躁动的发生,同时又不延长苏醒时间,值得进行临床推广和普及。

Objective To investigate the efficacy and safety of dexmedetomidine(DEX)by nasal dripping in surgery for pediatric hernia.Methods A total of 90 children undergoing elective hernia surgery were divided into 3 groups with 30 cases in each group by random number table method.They were divided into saline solution control group(control group),DEX 1.0μg/kg group(low dose group),DEX 2.0μg/kg group(high dose group).The time of anesthesia,operation,wake-up and extubation and total dosage of remifentanil and propofol during anesthesia were recorded,respectively.HR and SpO_(2) were recorded before and at 10 min,20 min and 30 min after intranasal DEX administration.After the operation,the agitation was evaluated by agitation scoring method on wake-up and at 15 min,30 min and 60 min after wake-up.Results There was no statistically significant difference in the time of anesthesia,operation,wake-up and extubation among the 3 groups(P>0.05).The dosage of remifentanil and propofol in control group was significantly higher than that in the other two groups,and the dosage in the high dose group was significantly lower than that in the low dose group,the difference being statistically significant.There was no significant difference in the HR at any time points(P>0.05).Compared with SpO_(2) before intranasal DEX administration,SpO_(2) in low dose group was decreased at 30 min(P<0.05),and SpO_(2) was decreased at every time points after intranasal administration in high dose group(P<0.05).SpO_(2) in high dose group was significantly lower than that of control group at every time points(P<0.05).The agitation scores after at each time point after wake-up in the high dose group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion Nasal dripping pretreatment with 2.0μg/kg DEX can significantly reduce the dosage of other intravenous anesthetics and the occurrence of agitation during hernia operation without prolonging the time of wake-up,which is worthy of clinical promotion and popularization.