右美托咪定经鼻腔黏膜给药对小儿腹腔镜疝修补术围术期血气指标及拔管质量的影响

Effects of Intranasal Mucosal Administration of Dexmedetomidine on Perioperative Blood Gas Indicators and Extubation Quality of Laparoscopic Hernia Repair in Children

目的:探讨右美托咪定(Dex)经鼻腔黏膜给药对小儿腹腔镜疝修补术围术期血气指标及拔管质量的影响。方法:选取2020年1月至2021年4月我院拟行腹腔镜疝修补术的患儿80例,根据随机数字表法分为对照组(n=26)、Dex 1组(n=27)和Dex 2组(n=27)。比较三组患儿术前、气腹后5 min以及放气后30 min动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))和pH值;比较三组患儿使用Dex前(T0)、Dex用药30 min后(T1)、手术开始3 min(T2)和手术结束3 min(T3)时血氧饱和度(SpO_(2))、心率(HR)、平均动脉压(MAP);比较三组患儿苏醒时间、拔管时间、拔管质量、躁动评分和不良反应发生率。结果:对照组气腹后5 min PaO_(2)、pH、PaCO_(2)分别为(73.16±7.45)mm Hg、7.21±0.06、(45.16±5.96)mm Hg;Dex 1组和Dex 2组气腹后5 min PaO_(2)分别为(78.46±6.64)mm Hg、(79.43±6.51)mm Hg,pH分别为7.38±0.10、7.49±0.08,均较对照组升高,PaCO_(2)分别为(40.14±4.19)mm Hg、(37.06±4.32)mm Hg,均较对照组降低(P<0.05);Dex 2组气腹后5 min pH高于Dex 1组,PaCO_(2)低于Dex 1组(P<0.05)。Dex 1组和Dex 2组T1、T2、T3时HR、MAP降低(P<0.05);Dex 2组T1、T3时HR低于Dex 1组,T1时MAP低于Dex 1组(P<0.05);Dex 1组和Dex 2组T1、T2、T3时HR、MAP均较T0时降低(P<0.05)。对照组拔管评分和躁动评分分别为(4.51±0.95)分、(13.25±2.59)分,Dex 1组拔管评分和躁动评分分别为(2.93±1.03)分、(9.27±2.23)分,Dex 2组拔管评分和躁动评分分别为(2.15±1.14)分、(6.38±2.62)分,与对照组比较,Dex 1组和Dex 2组拔管评分和躁动评分降低,且Dex 2组低于Dex 1组(P<0.05)。三组患儿苏醒时间、拔管时间、不良反应发生率比较,差异无统计学意义(P>0.05)。结论:经鼻腔黏膜给予Dex,可有效改善行腹腔镜疝修补术患儿围术期呼吸循环功能,减轻拔管应激反应和苏醒期躁动反应,且不延长拔管时间,不增加不良反应发生率,安全可靠。

Objective:To probe into the effects of intranasal mucosal administration of dexmedetomidine(Dex)on perioperative blood gas indicators and extubation quality of laparoscopic hernia repair in children.Methods:From Jan.2020 to Apr.2021,80 children undergoing laparoscopic hernia repair in our hospital were extracted to be divided into the control group(n=26),Dex 1 group(n=27)and Dex 2 group(n=27)via the random number table method.The arterial blood partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2))and pH were measured before surgery,5 minutes after pneumoperitoneum,and 30 minutes after deflation among three groups of children.Blood oxygen saturation(SpO_(2)),heart rate(HR)and mean arterial pressure(MAP)before administration of Dex(T0),30 min after administration of Dex(T1),3 min at the beginning of surgery(T2)and 3 min at the end of surgery(T3)were compared among three groups.The awaking time,extubation time,extubation quality,restlessness score and incidence of adverse drug reactions were compared among three groups.Results:The levels of PaO_(2),pH and PaCO_(2) at 5 min after pneumoperitoneum in the control group were respectively(73.16±7.45)mm Hg,7.21±0.06 and(45.16±5.96)mm Hg.The levels of PaO_(2) at 5 min after pneumoperitoneum in the Dex 1 and Dex 2 groups were respectively(78.46±6.64)mm Hg and(79.43±6.51)mm Hg,and pH values were respectively 7.38±0.10 and 7.49±0.08,all higher than those in the control group.The levels of PaCO_(2) in the Dex 1 and Dex 2 groups were respectively(40.14±4.19)mm Hg and(37.06±4.32)mm Hg,all lower than those in the control group(P<0.05).The pH at 5 min after pneumoperitoneum in Dex 2 group was higher than that in Dex 1 group,and PaCO_(2) was lower than that in Dex 1 group(P<0.05).HR and MAP at T1,T2 and T3 decreased in Dex 1 and Dex 2 groups(P<0.05).HR at T1 and T3 in Dex 2 group was lower than that in Dex 1 group,MAP at T1 was lower than that in Dex 1 group(P<0.05).HR and MAP at T1,T2 and T3 in Dex 1 and Dex 2 groups were lower than those at T0(P<0.05).The extubation scores and restlessness scores were(4.51±0.95)points and(13.25±2.59)points for the control group,(2.93±1.03)points and(9.27±2.23)points for the Dex 1 group,and(2.15±1.14)points and(6.38±2.62)points for the Dex 2 group,respectively.Compared with the control group,the extubation scores and restlessness scores of the Dex 1 group and Dex 2 group were lower,and the Dex 2 group was lower than the Dex 1 group(P<0.05).There were no statistically significant differences in the awakening time,extubation time and incidence of adverse drug reactions among three groups(P>0.05).Conclusion:The administration of Dex through the nasal mucosa can effectively improve the respiratory and circulatory function of children undergoing laparoscopic hernia repair,reduce the stress response to extubation and agitation during the recovery period,and does not prolong the extubation time or increase the incidence of adverse drug reactions with higher safety.