右美托咪定对鼾症患儿麻醉恢复期躁动、应激及炎性反应的影响

Effect of dexmedetomidine on the agitation,stress,and inflammatory response in the children with snoring during the anesthesia recovery period

目的评价右美托咪定对鼾症患儿麻醉恢复期躁动、应激及炎性反应的影响。方法选取2020年3月至2021年8月该院接受手术治疗的40例扁桃体肿大或腺样体肥大伴鼾症患儿为研究对象,采用随机数字表法分为观察组和对照组,每组20例。两组麻醉方案相同,术毕拔除气管导管,送患儿入麻醉恢复室。观察组经15 min静脉输注右美托咪定0.5μg/kg,对照组给予等容量生理盐水。记录两组入麻醉恢复室(T0)、预设药物输注结束(T1)、T1后30 min(T2)、T1后60 min(T3)时的心率(HR),平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))和呼吸;采用CRIES评分评价患儿疼痛情况,观察两组苏醒时间,记录呼吸抑制、心血管不良事件、补救镇痛率及苏醒期躁动的发生情况,采用小儿苏醒期烦躁量表(PAED)评价躁动程度。于T0、T3时检测血清超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平。结果与观察组比较,对照组T1、T2和T3时HR、MAP升高(P<0.05);与T0时比较,对照组T1、T2时HR升高,T1、T2和T3时MAP升高,两组T1、T2和T3时呼吸加快(P<0.05)。与对照组比较,观察组T1、T2和T3时CRIES评分降低(P<0.05)。观察期内两组无呼吸抑制及心血管事件的发生。与对照组比较,观察组苏醒时间延长,PAED评分及补救镇痛率降低(P<0.05)。与T0时比较,对照组T3时SOD水平降低,MDA、TNF-α和IL-6水平升高(P<0.05);与对照组比较,观察组T3时SOD水平升高,MDA、TNF-α和IL-6水平降低(P<0.05)。结论右美托咪定可降低鼾症患儿七氟醚麻醉恢复期躁动、应激和炎性反应的发生和程度。

Objective To evaluate the effect of dexmedetomidine on the agitation,stress,and inflammatory response in the children with snoring during the anesthesia recovery period.Methods A total of 40 children with tonsillar enlargement or adenoid hypertrophy with snoring in the hospital from March 2020 to August 2021 were divided into two groups(n=20 each)using the random number table method:the dexmedetomidine group(group D)and the control group(group C).The anesthesia scheme was the same in the two groups.After the operation,the tracheal tube was removed and the child was sent to the anesthesia recovery room.In group D,dexmedetomidine 0.5μg/kg was injected intravenously for 15 minutes,and the equal volume normal saline was injected intravenously in group C.The heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SpO_(2))and respiration(R)of the two groups were recorded at the time point of the anesthesia recovery room(T0),the end of pre-set drug infusion(T1),30 minutes(T2)after T1 and 60 minutes(T3)after T1.The“Crying,Requires O_(2) turation,Increased vital signs,Expression,Sleeplessness”(CRIES)score was used to evaluate the pain.The wake-up time of the two groups was observed.The respiratory depression,cardiovascular adverse events,the rate of remedial analgesia and the occurrence of restlessness in the wake-up period were recorded,and the pediatric anesthesia emergence delirium(PAED)scale was used to evaluate the degree of restlessness.At T0 and T3,the concentrations of serum superoxide dismutase(SOD),malondialdehyde(MDA),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were detected.Results Compared with those of group D,the HR and MAP increased at T1,T2 and T3 in group C(P<0.05).Compared with those of T0,the HR increased at T1 and T2,MAP increased at T1,T2 and T3(P<0.05),and R increased at T1,T2 and T3 in group C(P<0.05).Compared with that of group C,the scores of CRIES in group D decreased at T1,T2 and T3(P<0.05).Compared with those of group C,the recovery time of group D was prolonged,the PAED score and the rate of remedial analgesia decreased(P<0.05).Compared with those of T0,the concentration of SOD at T3 in group C decreased,and MDA,TNF-αand IL-6 increased(P<0.05).Compared with those of group C,the concentration of SOD at T3 in group D increased,and MDA,TNF-αand IL-6 decreased(P<0.05).Conclusion Dexmedetomidine can reduce the development and degree of agitation,stress,and inflammatory response following sevoflurane anesthesia in the children with snoring.