右美托咪定不同给药方式预防小儿术后不良行为改变的比较研究

A comparative study on different administration methods of dexmedetomidine in the prevention of negative postoperative adverse behavior in children

目的探讨右美托咪定术前滴鼻与术中静脉泵注对全麻患儿术后不良行为改变(NPOBCs)的影响。方法237例拟全麻下行腹腔镜疝囊高位结扎术的患儿按随机数字表法分为3组:P组(术前30 min经鼻滴注右美托咪定2μg/kg,诱导插管后给予生理盐水0.5 mL/kg静脉泵注10 min)、I组(术前30 min经鼻滴注生理盐水0.02 mL/kg、术中右美托咪定0.5μg/kg静脉泵注10 min)、C组(术前30 min经鼻滴注生理盐水0.02 m L/kg,诱导插管后给予生理盐水0.5 mL/kg静脉泵注10 min)。记录3组改良耶鲁术前焦虑评分(m YPAS)、诱导期合作(ICC)评分、拔管时间、苏醒时间、麻醉恢复室(PACU)时间,FLACC评分、躁动情况,在术后第1、7、30天采用术后行为学量表(PHBQ)对患儿父母进行电话随访,观察患儿术后行为改变的情况。结果与C组和I组比较,P组ICC评分降低(P<0.05);与C组和P组比较,I组拔管时间、苏醒时间、PACU时间延长(P<0.05);与C组比较,P组和I组FLACC评分、术后躁动和术后第1、7天NPOBCs及分离焦虑的发生率降低(P<0.05)。结论术前右美托咪定滴鼻和术中右美托咪定静脉泵注对于全麻患儿术后第1、7天NPOBCs均有改善,主要以减轻分离焦虑为主。2种给药方式对于NPOBCs的预防效果并无明显差异。

Objective dexmedetomidine on negative postoperative behavioral changes(NPOBCs)in children under general anesthesia.Methods A total of 237 children who underwent laparoscopic surgery were randomly divided into three groups:the group P(received intranasal dexmedetomidine 2μg/kg at the 30 minutes before operation,and intravenous infusion of saline 0.5 mL/kg for 10min after intubation),the group I(received intranasal 0.02 mL/kg normal saline 30 min before operation,and intravenous infusion of dexmedetomidine 0.5μg/kg for 10 min after intubation),the group C(received intranasal 0.02 mL/kg normal saline 30 min before operation,and intravenous infusion of saline 0.5 mL/kg for 10 min after intubation).Modified Yale Preoperative Anxiety Scale,ICC scores,extubation time,recovery time,PACU time,FLACC scores,agitation and perioperative adverse events were recorded.The parents were followed up by telephone at 1,7 and 30 days after operation using PHBQ.The behavior changes after operation were observed in children.Results Compared with the group C and the group I,the ICC scores decreased in the group P(P<0.05).Compared with the group C and the group P,the extubation time,recovery time and PACU time were prolonged in the group I(P<0.05).Compared with the group C,the FLACC scores and the incidence of agitation were significantly lower in the group P and the group I(P<0.05).Compared with the group C,the incidence of NPOBCs decreased on the 1st and 7th day after operation in the group P and the group I(P<0.05),and the incidence of separation anxiety decreased on the 1st and 7th day after operation in the group P and the group I(P<0.05).Conclusion The intranasal and intraoperative intravenous infusion dexmedetomidine in children undergoing laparoscopic surgery can improve NPOBCs on the 1st and 7th day after operation,mainly to reduce separation anxiety.There is no significant difference in the prevention intensity of NPBOCs between the two administration methods.