耳穴贴压联合经鼻给予右美托咪定用于患儿经胸超声心动图检查术的效果

Efficacy of auricular acupoint pressure therapy combined with intranasal dexmedetomidine for transthoracic echocardiography in pediatric patients

目的:评价耳穴贴压联合经鼻给予右美托咪定用于患儿经胸超声心动图检查术的效果。方法:择期门诊镇静下行经胸超声心动图检查术的先天性心脏病患儿117例,年龄3~36个月,体重5~20 kg,ASA分级Ⅱ或Ⅲ级。患儿分别采用经鼻给予右美托咪定或耳穴贴压联合经鼻给予右美托咪定的镇静方法进行经胸超声心动图检查术,2种镇静方法至少间隔1周。经鼻给予右美托咪定:双侧鼻孔经雾化器给予右美托咪定3μg/kg,每侧鼻孔给予1/2剂量。耳穴贴压联合经鼻给予右美托咪定:将王不留行籽耳贴贴于双侧脑、神门、交感、枕、皮质下、心、肝和脾穴,每个穴位按揉约1 min后,经鼻给予右美托咪定3μg/kg,每侧鼻孔给予1/2剂量。检查结束后带耳贴回家,每天按揉3次(睡前30 min必按揉1次),持续3 d。给予右美托咪定30 min内患儿美国密歇根大学镇静评分≥2分且体动评分≥2分为镇静成功。记录镇静起效时间、检查维持时间、等候时间、苏醒时间和镇静成功情况。记录给予右美托咪定后24 h内心动过缓、低血压、高血压、低氧血症、恶心呕吐、呼吸抑制、烦躁不安、过度活跃、动作失衡和过敏反应等不良反应的发生情况。记录术后恢复时间和夜间睡眠质量改善情况。结果:与经鼻给予右美托咪定比较,耳穴贴压联合经鼻给予右美托咪定镇静成功率和夜间睡眠质量改善率升高(P<0.05),不良反应发生率差异无统计学意义(P>0.05)。结论:与经鼻给予右美托咪定相比,耳穴贴压联合经鼻给予右美托咪定可提高患儿经胸超声心动图检查术的镇静成功率,改善镇静后夜间睡眠质量。

Objective To evaluate the efficacy of auricular acupoint pressure therapy combined with intranasal dexmedetomidine for transthoracic echocardiography in pediatric patients.Methods A total of 117 pediatric patients with congenital heart disease,of American Society of Anesthesiologists physical statusⅡorⅢ,aged 3-36 months,weighing 5-20 kg,scheduled for elective transthoracic echocardiography under outpatient sedation,were selected.Transthoracic echocardiography was performed under sedation using intranasally administered dexmedetomidine or using auricular acupoint pressure therapy combined with intranasal dexmedetomidine.The interval between the two sedation methods was at least 1 week.Intranasal dexmedetomidine:Dexmedetomidine 3μg/kg was administered to both nostrils via a nebulizer,with 1/2 dose in each nostril.Intranasal dexmedetomidine combined with auricular acupoint pressure:auricular acupressure with Wang Bu Liu Xing(semen vaccariae)seeds was used at the auricular acupoints.After each acupoint was rubbed for about 1 min,dexmedetomidine 3μg/kg was administered to both nostrils via a nebulizer,with 1/2 dose in each nostril.After the examination,auricular acupoint pressure therapy was continued at home,and pressing-rubbing at the acupoints was manipulated for 3 times daily,one of which was performed at 30 min before going to bed,for 3 consecutive days.When the University of Michigan Sedation Scale score≥2 and body movement score≥2 within 30 min after giving dexmedetomidine,sedation was considered to be successful.The onset time of sedation,examination time,waiting time,recovery time and the success of sedation were recorded.The incidence of adverse reactions such as bradycardia,hypotension,hypertension,hypoxemia,nausea and vomiting,respiratory depression,restlessness,hyperactivity,action imbalances and allergic reaction were recorded within 24 h after administration of dexmedetomidine.Time to recovery and improvement of sleep quality at night were recorded.Results Compared with intranasal dexmedetomidine,the successful rate of sedation and incidence of improvement of sleep quality at night were significantly increased(P<0.05),and no significant change was found in adverse reactions using intranasal dexmedetomidine combined with auricular acupoint pressure(P>0.05).Conclusion Intranasal dexmedetomidine combined with auricular acupoint pressure therapy can increase the successful rate of sedation and improve the sleep quality at night in pediatric patients undergoing transthoracic echocardiography when compared to intranasal dexmedetomidine.