右美托咪定对小儿扁桃体和腺样体切除术后镇静镇痛的影响

Effects of dexmedetomidine on sedation and analgesia after tonsillectomy and adenoidectomy in children

目的分析右美托咪定对小儿扁桃体和腺样体切除术后镇静、镇痛的影响。方法选择48例扁桃体和腺样体切除患儿为研究对象,按照随机数字表法分为右美托咪定组和对照组,每组24例。两组采用相同麻醉方式,在此基础上,右美托咪定组加用右美托咪定0.1μg/kg,对照组泵注等容量生理盐水。比较两组拔管后(T1)、自主呼吸恢复后(T2)、返回病房后(T3)、返回病房2 h(T4)、返回病房6 h(T5)、返回病房12 h(T6)和返回病房24 h(T7)的儿童疼痛观察量表(POCIS)、汉化简化版改良耶鲁术前焦虑量表(mYPAS-SF)评分及小儿麻醉苏醒期谵妄量表(PAED)评分,气管插管拔除时间、自主呼吸恢复时间、拔管后麻醉恢复室(PACU)停留时间及镇痛药物补救情况,不良事件发生情况。结果T1、T2、T3、T4、T5、T6和T7时,右美托咪定组POCIS评分分别为(0.83±0.38)、(1.29±0.46)、(4.75±0.90)、(4.79±0.72)、(4.29±0.69)、(3.54±0.59)、(2.13±0.90)分,均低于对照组的(1.17±0.57)、(2.08±0.58)、(5.29±0.81)、(5.33±0.82)、(4.88±0.90)、(4.04±0.62)、(2.75±0.90)分,差异均有统计学意义(P<0.05);右美托咪定组PAED评分分别为(7.17±2.08)、(11.00±2.02)、(10.83±2.33)、(8.00±2.02)、(8.54±1.98)、(7.50±1.64)、(3.88±1.75)分,均低于对照组的(10.00±2.25)、(13.92±2.72)、(13.67±2.75)、(10.08±1.98)、(9.67±1.71)、(9.13±1.70)、(5.04±1.55)分,差异均有统计学意义(P<0.05);右美托咪定组mYPAS-SF评分分别为(75.96±8.56)、(81.50±8.75)、(80.67±8.48)、(75.13±6.33)、(66.00±4.62)、(56.58±6.00)、(40.71±5.82)分,均低于对照组的(81.21±7.30)、(86.58±7.24)、(87.50±7.74)、(81.08±6.76)、(73.63±5.87)、(60.67±4.72)、(44.33±6.11)分,差异均有统计学意义(P<0.05)。两组术后气管插管拔除时间、自主呼吸恢复时间、拔管后PACU停留时间及镇痛药物补救率比较,差异无统计学意义(P>0.05)。两组PACU均内未出现心动过缓、恶心呕吐、喉痉挛、氧饱和度下降等不良事件。结论小儿扁桃体和腺样体切除术采用0.1μg/kg右美托咪定泵入不影响麻醉恢复,不增加术后不良事件,能安全有效地缓解患儿术后早期疼痛、焦虑及谵妄情况。

Objective To analyze the effects of dexmedetomidine on sedation and analgesia after tonsillectomy and adenoidectomy in children.Methods A total of 48 children with tonsillectomy and adenoidectomy were selected as the research subjects,and were divided into a dexmedetomidine group and a control group according to the random numerical table,with 24 cases in each group.Both groups were given the same anesthesia method.On this basis,the dexmedetomidine group was added with 0.1μg/kg of dexmedetomidine,and the control group was pumped with an equal volume of normal saline.Both groups were compared in terms of pain observation scale for young children(POCIS)score,modified Yale preoperative anxiety scale-short form(mYPAS-SF)score and pediatric anesthesia emergence delirium(PAED)score after extubation(T1),after recovery of spontaneous breathing(T2),after spontaneous breathing recovery(T2),after returning to the ward(T3),2 h returning to the ward(T4),6 h returning to the ward(T5),12 h returning to the ward(T6)and 24 h returning to the ward(T7),extubation time,recovery time of spontaneous breathing,post anesthesia care unit(PACU)stay duration after extubation and remediation of analgesic drugs,as well as the occurrence of adverse events.Results At T1,T2,T3,T4,T5,T6 and T7,the POCIS scores of the dexmedetomidine group were(0.83±0.38),(1.29±0.46),(4.75±0.90),(4.79±0.72),(4.29±0.69),(3.54±0.59)and(2.13±0.90)points,which were lower than(1.17±0.57),(2.08±0.58),(5.29±0.81),(5.33±0.82),(4.88±0.90),(4.04±0.62)and(2.75±0.90)points of the control group,and the differences were all statistically significant(P<0.05).At T1,T2,T3,T4,T5,T6 and T7,the PAED scores of the dexmedetomidine group were(7.17±2.08),(11.00±2.02),(10.83±2.33),(8.00±2.02),(8.54±1.98),(7.50±1.64),and(3.88±1.75)points,which were lower than(10.00±2.25),(13.92±2.72),(13.67±2.75),(10.08±1.98),(9.67±1.71),(9.13±1.70)and(5.04±1.55)points of the control group,and the differences were all statistically significant(P<0.05).At T1,T2,T3,T4,T5,T6 and T7,the mYPAS-SF scores of the dexmedetomidine group were(75.96±8.56),(81.50±8.75),(80.67±8.48),(75.13±6.33),(66.00±4.62),(56.58±6.00)and(40.71±5.82)points,which were lower than(81.21±7.30),(86.58±7.24),(87.50±7.74),(81.08±6.76),(73.63±5.87),(60.67±4.72)and(44.33±6.11)points of the control group,and the differences were all statistically significant(P<0.05).There was no statistically significant difference in extubation time,recovery time of spontaneous breathing,PACU stay duration after extubation and remediation of analgesic drugs between the two groups(P>0.05).There were no adverse events such as bradycardia,nausea and vomiting,laryngospasm,and decreased oxygen saturation within the PACU in both groups.Conclusion Pediatric tonsil and adenoidectomy with 0.1μg/kg dexmedetomidine pumping does not affect recovery from anesthesia,does not increase postoperative adverse events,and can safely and effectively relieve early postoperative pain,anxiety,and delirium in children.