右美托咪定滴鼻在小儿肺功能检查中的镇静效果

Effect of dexmedetomidine nasal drops on pulmonary function tests in children

目的评价右美托咪定滴鼻在小儿肺功能检查中的临床效果。方法选取2021年6月至2021年12月于吉林大学第一医院小儿呼吸科行肺功能检查的患儿120例,采用随机数字表法将患儿分为A组(n=40)、B组(n=40)和C组(n=40)。A组患儿采用10%的水合氯醛按50~80mg/kg保留灌肠,B组和C组患儿分别于检查前30min将右美托咪定原液按照2.0μg/kg和3.0μg/kg进行滴鼻。待患儿睫毛反射消失后开始肺功能检查。记录3组患儿镇静前(T0)、镇静后10min(T1)、20min(T2)和30min(T3)时的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、呼吸频率(respiratory rate,RR)及脉搏血氧饱和度(pulse oxygen saturation,SpO_(2))。记录3组患儿镇静前、镇静后10min、20min和30min时的警觉/镇静观察评分(observer’s assessment of alertness/sedation scale,OAA/S)和镇静成功率,以及3组患儿镇静期间不良反应发生情况。结果T0时,3组患儿的MAP、HR比较,差异均无统计学意义(P>0.05)。T1时,3组患儿MAP、HR均显著低于T0(P<0.05),A组和B组患儿在T1时的MAP、HR显著高于C组(P<0.05)。T2、T3时,3组患儿的MAP和HR比较,差异均无统计学意义(P>0.05)。在不同时间点3组患儿的RR及SpO_(2)比较,差异均无统计学意义(P>0.05)。与A组和B组比较,C组患儿镇静成功率显著升高(P<0.05)。与B组比较,A组和C组镇静起效时间显著缩短(P<0.05);3组患儿的苏醒时间比较,差异无统计学意义(P>0.05)。镇静期间B组和C组的不良反应总发生率显著低于A组(P<0.05)。结论右美托咪定2μg/kg滴鼻用于小儿肺功能检查可有效提高患儿的检查依从性,镇静成功率明显高于水合氯醛,且镇静期间生命体征平稳,不良反应发生率低,镇静失败补救追加右美托咪定至3μg/kg,可安全应用于临床。

Objective To evaluate the clinical effect of dexmedetomidine nasal drops on pulmonary function tests in children.Methods A total of 120 children who underwent pulmonary function tests in pediatric respiratory department of the First Hospital of Jilin University from June 2021 to December 2021 were selected and divided into group A(n=40),group B(n=40)and group C(n=40)according to random number table method.group A was given 10%chloral hydrate 50-80mg/kg retention enema,and children in group B and group C received nasal drops of dexmedetomidine stock solution at 2.0μg/kg and 3.0μg/kg respectively 30 minutes before the examination.After eyelash reflex of children disappeared,the examination was performed.Mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR)and pulse oxygen saturation(SpO_(2))of children were recorded before sedation(T0),10min(T1),20min(T2)and 30min(T3)after sedation in three groups.The observer’s assessment of alertness/sedation scale(OAA/S)and the success rate of sedation were recorded before sedation,at 10min,20min and 30min after sedation.The adverse reactions during sedation was recorded in the three groups.Results At T0,the MAP and HR of the three groups of children were compared,and the differences were not statistically significant(P>0.05).At T1,the MAP and HR of the three groups of children were significantly lower than those of T0(P<0.05),and the MAP and HR of the children of group A and group B were significantly higher than those of group C at T1(P<0.05).At T2 and T3,the MAP and HR of the three groups were compared,and the differences were not statistically significant(P>0.05).Comparison of RR and SpO_(2) of children in the three groups at different time points showed no statistically significant difference(P>0.05).Compared with groups A and B,the sedation success rate of children in group C was significantly higher(P<0.05).Compared with group B,the onset of sedation in group A and group C was significantly shorter(P<0.05).The difference in the awakening time of the children in the three groups was not statistically significant(P>0.05).The total incidence of adverse reactions during sedation in Groups B and C was significantly lower than that in group A(P<0.05).Conclusion Dextrmedetomidine 2μg/kg nasal drops can effectively improve the compliance of children's pulmonary function examination.The success rate of sedation is significantly higher than that of chloral hydrate.During sedation,the vital signs are stable,and the incidence of adverse reactions is low.Dextrmedetomidine is added to 3μg/kg to remedy sedation failure,which can be safely used in clinical practice.