右美托咪定对小儿扁桃体腺样体切除术后苏醒期躁动、拔管反应及血流动力学的影响

Effects of dexmedetomidine on agitation,extubation reaction and hemodynamics in children after tonsillectomy

目的 探讨右美托咪定对小儿扁桃体腺样体切除术后苏醒期躁动、拔管反应及血流动力学的影响。方法 选取郑州中心医院2019年12月至2020年12月收治的103例行扁桃体腺样体切除术的患儿,参考随机数字表法分为对照组(n=52)和观察组(n=51)。观察组持续泵入0.4μg/(kg·h)右美托咪定;对照组持续泵注等容量的0.9%生理盐水。比较两组患儿临床指标(睁眼时间、呛咳评分、拔管时间)、苏醒期躁动评分分级状况、血流动力学指标[心率(HR)、血氧饱和度(SpO_(2))、平均动脉压(MAP)]及不良反应发生率。结果 观察组睁眼时间、呛咳评分均低于对照组[(9.45±1.67)vs.(20.13±2.36)、(1.35±0.21)vs.(2.42±0.37)](P<0.05);观察组躁动评分分级状况优于对照组(P<0.05);T_(4)、T_(5)时刻观察组MAP、HR水平低于对照组,SpO_(2)水平高于对照组(P<0.05);观察组不良反应发生率1.96%低于对照组的13.46%(P<0.05)。结论 右美托咪定可以有效改善小儿扁桃体腺样体切除术术后拔管反应和苏醒期躁动,促进血流动力学稳定,安全性高。

Objective To investigate the effects of dexmedetomidine on agitation,extubation reaction and hemodynamics in children after tonsillectomy.Method Totally 103 children who underwent tonsillectomy from December 2019 to December 2020 were randomly divided into control group(n=52)and observation group(n=51).The observation group was continuously pumped with 0.4μg/(kg·h)dexmedetomidine;The control group was continuously pumped with equal volume of 0.9%normal saline.The clinical indexes(eye opening time,choking cough score,extubation time),the classification of agitation score in awakening period,hemodynamic indexes[heart rate(HR),blood oxygen saturation(SpO_(2)),mean arterial pressure(MAP)]and the incidence of adverse reactions were observed and compared between the two groups.Result The eye opening time and cough score in the observation group were lower than those in the control group[(9.45±1.67)vs.(20.13±2.36)、(1.35±0.21)vs.(2.42±0.37)](P<0.05);The restlessness score of the observation group was better than that of the control group(P<0.05);At T_(4) and T_(5),the levels of map and HR in the observation group were lower than those in the control group,and the level of SpO_(2) was higher than those in the control group(P<0.05);The incidence of adverse reactions in the observation group(1.96%)was lower than that in the control group(13.46%)(P<0.05).Conclusion Dexmedetomidine can effectively improve the extubation reaction and agitation in recovery period after tonsillectomy in children,promote hemodynamic stability and high safety.