右美托咪定不同给药方式对小儿术后躁动及应激反应的影响

Effects of Different Administration Methods of Dexmedetomidine on Postoperative Agitation and Stress Response in Children

目的探讨右美托咪定不同给药方式对地氟烷麻醉患儿术后躁动及应激反应的影响。方法选取医院2018年3月至2020年10月收治的地氟烷麻醉后手术患儿82例,按随机数字表法分为观察组和对照组,各41例。观察组患儿麻醉诱导前静脉泵注右美托咪定,对照组患儿采取右美托咪定滴鼻给药。结果观察组患儿苏醒时间、气管导管移除时间、麻醉后监测治疗室停留时间均显著短于对照组(P<0.05),观察组患儿气管插管时、手术开始时的血清皮质醇、去甲肾上腺素水平均显著低于对照组(P<0.05);两组患儿平均动脉压、心率及术后儿童麻醉苏醒期躁动评估量表(PAED)评分、东安大略儿童医院疼痛评分量表(CHEOPS)评分、Ramsay镇静评分量表评分差异均无统计学意义(P>0.05)。观察组和对照组患儿恶心呕吐、心动过缓、低氧血症发生率相当(4.88%比2.44%,0比2.44%,2.44%比4.88%,P>0.05),均未发生呼吸抑制。结论右美托咪定滴鼻和静脉泵注给药均能有效降低地氟烷麻醉术后患儿的躁动反应,静脉泵注给药更利于减轻机体应激反应,缩短术后苏醒时间。

Objective To investigate effects of different administration methods of dexmedetomidine on postoperative agitation and stress response in children anesthetized with desflurance.Methods Eighty-two children ansthetized with desflurane admitted to the hospital from March 2018 to October 2020 were selected and divided into the observation group and control group according to the random number table method,with 41 cases in each group.The children in the observation group were given dexmedetomidine intravenously before anesthesia induction,while the children in the control group were given dexmedetomidine intranasally before anesthesia induction.Results The recovery time,removal time of tracheal catheter and residence time in postanesthesia care unit(PACU)in the observation group were significantly shorter than those in the control group(P<0.05).The levels of serum cortisol(Cor)and norepinephrine(NE)at the time of tracheal intubation and the beginning of operation in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the mean arterial pressure(MAP),heart rate(HR)and scores of Pediatric Anesthesia Emergence Delirium(PAED)Scale,Children′s Hospital of Eastern Ontario Pain Scale(CHEOPS)and Ramsay Sedation Scale(RSS)between the two groups(P>0.05).The incidence of nausea,vomiting,bradycardia and hypoxemia in the observation group was similar to that in the control group(4.88%vs.2.44%,0 vs.2.44%,2.44%vs.4.88%,P>0.05).There was no respiratory depression in both groups.Conclusion Both intranasal and intravenous pumping of dexmedetomidine can effectively reduce the postoperative agitation of children anesthetized with desflurance.However,intravenous pumping of dexmedetomidine is more beneficial to reduce stress response and shorten postoperative recovery time.