右美托咪定滴鼻在小儿腹腔镜疝修补术中的镇痛镇静效果

Analgesic and sedative effects of dexmedetomidine nasal drops on laparoscopic hernioplasty in children and the quality of extubation

目的 探讨右美托咪定滴鼻对小儿腹腔镜疝修补术中的镇痛镇静效果及拔管质量。方法 选取2021年3月至2022年9月在浙江省金华市妇幼保健院行腹腔镜疝修补术的患儿94例,根据不同麻醉用药分为右美托咪定组(47例)和0.9%氯化钠注射液组(47例),右美托咪定组采用1μg/kg右美托咪定滴鼻,0.9%氯化钠注射液组滴入等容量0.9%氯化钠注射液。比较2组患儿的拔管时间、苏醒时间及麻醉后监测治疗室(PACU)滞留时间,麻醉诱导前(T0)、插管即刻(T1)、插管后5 min(T2)、手术结束时(T3)、拔管即刻(T4)的平均动脉压(MAP)、心率、血氧饱和度(SpO_(2))水平,拔管后10、20、30、40 min疼痛视觉模拟评分(VAS)、 Richer镇静躁动评分(SAS)发生率。结果 T1、T2、T3、T4时观察组MAP、心率水平均低于对照组(P均<0.05),T1、T2、T3、T4时2组SpO_(2)水平差异无统计学意义(P>0.05),拔管后20、30、40 min时观察组VAS、SAS评分均低于对照组(P均<0.05);观察组拔管时间、苏醒时间及麻醉后PACU滞留时间及躁动发生率低于对照组(P均<0.05)。结论右美托咪定滴鼻能够有效稳定患儿血流动力学,有效改善对患儿的镇静镇痛,提升拔管质量。

Objective To investigate the analgesic and sedative effects of dexmedetomidine nasal drops on laparoscopic hernioplasty in children and the quality of extubation.Methods A total of 94 children who un-derwent laparoscopic hernioplasty in Jinhua Maternal and Child Health Hospital from March 2021 to September 2022 were selected,and they were divided into a control group and an observation group according to different anesthetic drugs,with 47 cases in each group.The observation group received 1μg/kg dexmedetomidine nasal drops,while the control group received 0.9%sodium chloride injection nasal drops at equal volume.Compared mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO_(2))levels at the following time points:before anesthesia induction(T0),immediately after intubation(T1),5 minutes after intubation(T2),at the end of surgery(T3),and immediately after intubation(T4).Additionally,the visual analog scales(VAS),Ramsay sedation score(RSS),and restlessness rate at 10,20,30,and 40 minutes after extubation were compared.Results At T1,T2,T3 and T4,the levels of MAP and HR in the observation group were lower than those in the control group(P<0.05).There were no statistically significant differences in the levels of SpO_(2) between the two groups at T1,T2,T3,and T4(P>0.05).The VAS and SAV in the observation group were lower than those in the control group at 20,30 and 40 minutes after extubation(P<0.05).The extubation time,awakening time,PACU retention time and restlessness rate in the observation group were lower than those in the control group(P<0.05).Conclu-sion Dextrmetomidine nasal drops can effectively stabilize the hemodynamics of children,effectively improve seda-tion and analgesia,and enhance the quality of extubation.