右美托咪定不同给药方式对儿童扁桃体腺样体切除术后恢复的影响

Effect of Different Administration Methods of Dexmedetomidine on Recovery After Tonsillectomy and Adenoidectomy in Children

目的:探讨右美托咪定(Dex)不同给药方式对儿童扁桃体腺样体切除术后恢复的影响。方法:选取2022年11月—2023年2月于安徽省儿童医院在七氟烷全身麻醉下行扁桃体腺样体切除术的90例患儿作为研究对象,根据随机数字表法分为静脉组、滴鼻组、对照组,各30例。三组均采用丙泊酚3 mg/kg、舒芬太尼0.4μg/kg、罗库溴铵0.6 mg/kg进行麻醉;静脉组在10 min内静脉泵注Dex 1 mg/kg,滴鼻组经鼻滴入Dex 2 mg/kg,对照组静脉泵注等剂量生理盐水。比较三组麻醉效果。结果:静脉组苏醒、麻醉后恢复室(PACU)驻留时间长于滴鼻组与对照组,差异有统计学意义(P<0.05)。呼之睁眼即刻与呼之睁眼10、20、30 min,静脉组与滴鼻组躁动、疼痛评分均低于对照组,差异有统计学意义(P<0.05)。静脉组与滴鼻组苏醒期躁动发生率均低于对照组,差异有统计学意义(P=0.029)。诱导后10 min、拔管即刻、入PACU 10 min,静脉组心率低于滴鼻组与对照组变化,差异有统计学意义(P<0.05)。结论:Dex可降低扁桃体腺样体手术后EA发生率,且滴鼻给药方式可缩短苏醒时间,镇痛持久,可更好地进行扁桃体腺样体手术围术期管理。

Objective:To investigate the effect of different administration methods of dexmedetomidine(Dex)on recovery after tonsillectomy and adenoidectomy in children.Methods:A total of 90 children who underwent tonsillectomy and adenoidectomy under general anesthesia using sevoflurane in Anhui Provincial Children's Hospital from November 2022 to February 2023 were selected as the study subjects.According to a random number table method,children were divided into intravenous group,intranasal group and control group,with 30 cases in each group.Propofol 3 mg/kg,sufentanil 0.4μg/kg,and rocuronium bromide 0.6 mg/kg were used for anesthesia in all three groups.The intravenous group was intravenously pumped with Dex 1 mg/kg within 10 min,the intranasal group was intranasally dripped with Dex 2 mg/kg,and the control group was intravenously pumped with equal doses of normal saline.The effects of anesthesia in the three groups were compared.Results:The awakening time and Postanesthesia Care Unit(PACU)residence time in intravenous group were longer than those in intranasal group and control group,with a statistically significant difference(P<0.05).At 10,20 and 30 min of eye opening to verbal stimulus,the scores of agitation and pain in intravenous group and intranasal group were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of agitation during awakening in intravenous group and intranasal group was lower than that in the control group,and the difference was statistically significant(P=0.029).At 10 min after induction,immediately after extubation,and at 10 min after entering PACU,the heart rate in intravenous group was lower than that in the intranasal group and the control group,and the difference was statistically significant(P<0.05).Conclusion:Dex can reduce the incidence of EA after tonsillectomy and adenoidectomy,and the nasal drip administration method can shorten awakening time and have long-lasting pain relief,which achieve better perioperative management of tonsillectomy and adenoidectomy.