右美托咪定对腹腔镜手术患儿应激反应及术后恢复的影响

Effects of dexmedetomidine on stress response and postoperative recovery in children undergoing laparoscopic surgery

目的观察右美托咪定对腹腔镜手术患儿应激反应及术后恢复的影响。方法选择2021年5月至2022年12月金华市妇幼保健院收治的腹腔镜手术患儿200例为研究对象,采用前瞻性随机对照研究方法,按照随机数字表法分成A组与B组,A组(100例)于麻醉诱导前静脉输注0.9%氯化钠注射液,B组(100例)于麻醉诱导前静脉输注0.5μg/kg右美托咪定,其余麻醉方法相同。比较两组各时间点[输注前(T0)、输注后10 min(T1)、术后清醒时(T2)、拔管后5 min(T3)]患儿的生命体征(平均动脉压、心率)、应激反应(去甲肾上腺素、皮质醇、血糖)、术后恢复情况(睁眼时间、定向力恢复时间、拔管时间)、躁动情况(躁动评分、躁动持续时间)以及不良反应(恶心、呕吐、心动过速、喉痉挛、呼吸抑制)发生情况。结果B组T1、T2、T3的平均动脉压、心率[(81.53±7.45)mmHg(1 mmHg=0.133 kPa)、(78.32±8.23)mmHg、(85.73±7.28)mmHg,(109.43±7.78)次/min、(106.22±7.25)次/min、(112.34±6.74)次/min]均高于A组[(76.39±7.21)mmHg、(73.54±7.41)mmHg、(80.34±6.81)mmHg,(102.58±7.34)次/min、(99.14±6.90)次/min、(107.76±6.38)次/min](t=4.95、4.31、5.40、6.40、7.07、4.93,均P<0.001);B组术后1 d的去甲肾上腺素、皮质醇、血糖水平[(352.73±60.32)ng/L、(310.85±67.61)nmol/L、(4.89±0.97)mmol/L]均低于A组[(427.82±72.95)ng/L、(375.33±74.97)nmol/L、(5.53±1.10)mmol/L](t=7.93、6.38、4.36,均P<0.001);B组睁眼、定向力恢复、拔管的时间[(10.06±1.93)min、(10.54±2.10)min、(11.92±2.06)min]均短于A组[(11.88±2.14)min、(12.43±2.65)min、(14.46±2.43)min](t=6.31、5.59、7.97,均P<0.001);B组PAED评分[(8.19±2.10)分]低于A组的(11.56±2.62)分,躁动持续时间[(7.41±1.27)min]短于A组的(9.33±1.65)min,两组差异均有统计学意义(t=10.03、9.22,均P<0.001);B组不良反应发生率为6.00%(6/100),与A组的8.00%(8/100)差异无统计学意义(χ^(2)=0.30,P>0.05)。结论右美托咪定在小儿腹腔镜手术中的应用效果较好,能够稳定患儿生命体征,减轻应激反应,有助于术后恢复,且能减轻患儿躁动,减少不良反应。

Objective To investigate the effects of dexmedetomidine on stress response and postoperative recovery in children undergoing laparoscopic surgery.Methods A total of 200 pediatric patients undergoing laparoscopic surgery who received treatment in Jinhua Maternal and Child Health Hospital from May 2021 to December 2022 were included in this prospective randomized controlled study.These patients were randomly divided into Group A and Group B.Group A(n=100)received an intravenous infusion of physiological saline before anesthesia induction,while Group B(n=100)received an intravenous infusion of 0.5μg/kg dexmedetomidine,and the other anesthesia methods were the same as the Group A.Vital signs(mean arterial pressure,heart rate),stress reactions(norepinephrine,cortisol,blood glucose),postoperative recovery status(eye-opening time,time to orientation,extubation time),the occurrence of restlessness(restlessness score,duration of restlessness),and adverse reactions(nausea,vomiting,tachycardia,laryngeal spasm,respiratory depression)were compared between different time points[before infusion(T0),10 minutes after infusion(T1),postoperative wakefulness(T2),and 5 minutes after extubation(T3)].Results At T1,T2,T3,the mean arterial pressure and heart rate in Group B[(81.53±7.45)mmHg(1 mmHg=0.133 kPa),(78.32±8.23)mmHg,(85.73±7.28)mmHg,(109.43±7.78)beats/minute,(106.22±7.25)beats/minute,and(112.34±6.74)beats/minute]were significantly higher than those in Group A[(76.39±7.21)mmHg,(73.54±7.41)mmHg,(80.34±6.81)mmHg,(102.58±7.34)beats/minute,(99.14±6.90)beats/minute,(107.76±6.38)beats/minute,t=4.95,4.31,5.40,6.40,7.07,4.93,all P<0.001].At 1 day after surgery,the levels of norepinephrine,cortisol,and blood glucose in Group B[(352.73±60.32)ng/L,(310.85±67.61)nmol/L,(4.89±0.97)mmol/L]were significantly lower than those in Group A[(427.82±72.95)ng/L,(375.33±74.97)nmol/L,(5.53±1.10)mmol/L,t=7.93,6.38,4.36,P<0.001].The time to eye-opening,time to orientation,and time to extubation in Group B were(10.06±1.93)minutes,(10.54±2.10)minutes,and(11.92±2.06)minutes,respectively,which were significantly shorter than(11.88±2.14)minutes,(12.43±2.65)minutes,and(14.46±2.43)minutes(t=6.31,5.59,7.97,all P<0.001).The pediatric anesthesia emergence delirium score in Group B was(8.19±2.10)points,which was significantly lower than(11.56±2.62)points in Group A(t=10.03,P<0.001).The duration of restlessness in Group A was(7.41±1.27)minutes,which was significantly shorter than(9.33±1.65)minutes in Group B(t=9.22,P<0.001).There was no significant difference in the incidence of adverse reactions between Group A and Group B[8.00%(8/100)vs.6.00%(6/100),χ^(2)=0.30,P>0.05].Conclusion Dexmedetomidine has a good application effect in pediatric laparoscopic surgery.It can stabilize the vital signs of children,reduce stress reactions,facilitate postoperative recovery,and reduce restlessness and adverse reactions.