右美托咪定在七氟醚全麻下儿童扁桃体及腺样体切除术中的应用

Application of Dexmedetomidine in Tonsillectomy and Adenoidectomy in Children Under General Anesthesia with Sevoflurane

目的探讨单次应用右美托咪定在七氟醚全麻下儿童扁桃体及腺样体切除术麻醉中的临床效果。方法选取2021年5月至2022年5月在我院七氟醚全麻下行鼻内镜下扁桃体及腺样体切除术的儿童患者80例,年龄4~8岁,不限性别,ASA分级为I级或II级,BMI指数正常,将患儿随机分为试验组D(n=40)和对照组C(n=40)。麻醉诱导后10 min内分别给予右美托咪定0.5μg/kg(D组)或等量生理盐水(C组)。分别观察两组患儿血流动力学变化和术后恢复情况,记录患儿麻醉前(T0)、插管时(T1)、支撑喉镜时(T2)、拔管时(T3)、拔管后5 min(T4)、出麻醉后恢复室(PACU)时(T5)的心率(HR)和平均动脉压(MAP),运用小儿麻醉苏醒躁动评分量表(PAED)和疼痛行为评分量表(FLACC)评分对患儿进入PACU后30 min内的躁动发生及疼痛情况进行评分,并记录两组患儿手术时间、拔管时间、PACU停留时间、拔管后住院时间并观察两组患儿不良事件和术后负性行为改变(NPOBC)的发生率。结果两组患儿T0和T5时的MAP和HR比较,差异无统计学意义(P>0.05),但D组在T2、T3、T4时MAP和HR明显低于C组(P<0.05)。与C组相比,右美托咪定可降低患儿术后ED发生率(33.3%vs.60.0%,P=0.013)和疼痛发生率(32.5%vs.65.0%,P=0.017),但延长拔管时间(10.7±3.4 vs.14.3±4.1,P<0.001)。两组拔管后的PACU停留时间、住院时间和不良事件的发生率相似。D组出院后第1天和第7天NPOBC发生率显著低于C组(分别为17.5%vs.42.5%,P=0.027和10.0%vs.7.5%,P=0.028),但两组患儿第30天NPOBC的发生率差异无统计学意义。结论右美托咪定0.5μg/kg可运用于七氟醚全麻下儿童鼻内镜下扁桃体及腺样体切除术,临床效果显著。

Objective To investigate the clinical effect of dexmedetomidine in tonsillectomy and adenoidectomy of children under general anesthesia with sevoflurane.Methods Eighty pediatric patients,aged 4~8 years,who underwent nasal endoscopic tonsillectomy and adenoidectomy in our hospital from May 2021 to May 2022,were randomly divided into experimental group D(n=40)and control group C(n=40),with ASA grade I or II and normal BMI.Dexmedetomidine was given by 0.5μg/kg(group D)or equivalent amount of normal saline(group C)within 10 min after induction of anesthesia.The hemodynamic changes and postoperative recovery of the two groups were observed respectively.Heart rate and mean arterial pressure(MAP)before anesthesia(T0),during intubation(T1),during laryngoscopy support(T2),during extubation(T3),at 5 minutes after extubation(T4)and PACU exit(T5)were recorded.The incidence of agitation and pain within 30 min after entering the post-anesthesia recovery room(PACU)were scored by using the Pediatric Anesthesia recovery Agitation Scale(PAED)and pain Behavior Scale(FLACC).Operation time,extubation time,PACU stay time and length of hospital stay after extubation were recorded,and the incidence of adverse events and postoperative negative behavior changes(NPOBC)were observed in the two groups.Results There were no significant differences in MAP and HR between the two groups at T0 and T5(P>0.05),but the MAP and HR of group D at T2,T3 and T4 were significantly lower than those of group C(P<0.05).Comparing with the control group(group C),dexmedetomidine reduced the incidence of postoperative ED(33.3%vs.60.0%,P=0.013)and the incidence of pain(32.5%vs.65.0%,P=0.017),but prolonged extubation time(10.7±3.4 vs.14.3±4.1,P<0.001).PACU length of stay,length of hospital stay,and percentage of adverse events after extubation were similar between the two groups.The incidence of NPOBC in group D was significantly lower than that in group C on day 1 and 7 after discharge(17.5%vs.42.5%,respectively,P=0.027 and 10.0%vs.37.5%,P=0.028),but there was no significant difference on day 30 after discharge.Conclusion Dexmedetomidine 0.5μg/kg for tonsils and adenoidectomy in children under general anesthesia with sevoflurane is clinically satisfied.