右美托咪定喷鼻对小儿室间隔缺损封堵术前镇静镇痛及术后躁动的影响

摘要

Objective To explore the clinical effect of intranasal dexmedetomidine on preoperative sedation and analgesia and postoperative agitation in children undertaking occlusion of ventricular septal defect.Methods Using a computer-generated randomization schedule,ninety 2 to 6 yearrs old children undertaking occlusion of ventricular septal defect were enrolled and divided into three groups,30 cases per group.The children in group A were pretreated with midazolam 0.2 mg/kg by nasal drip 30 min before operation.The children in group B or group C were intranasally given dexmedetomidine 1.0 and 2.0 μg/kg 30 min before operation,respectively.The heart rate (HR),mean artery blood pressure (MAP),oxygen saturation (SPO2) and bispectral index (BIS) of the children were recorded at baseline (T0),5 (T1),15 (T2),and 25 min (T3) after intranasal administration,10 min after anesthesia induction (T4),30 min after the beginning of operation (T5),at the end of operation (T6),and 30 min after operation (T7),respectively.The observer's assessment of alertness/sedation scale (OAA/S) was performed from T0 to T3 in the three groups.Calm mood score when children and parents separated and venipuncture acceptance score were recorded in the three groups.The score of postoperative agitation and the adverse reactions after operation were analyzed in the three groups.Results Compared with group A,the OAA/S [(5.6±0.7) vs.(4.5±0.9),F=24.430 0,P ＜ 0.000 1;(4.8±0.7) vs.(3.5±1.0),F=36.670 0,P ＜ 0.000 1] were lower from T2 to T3 and the HR,MAP,and BIS were lower (P ＜ 0.05) from T2 to T3 and from T6 to T7 in group C.Compared to group A and group B,the calm mood score when children and parents separated [(2.3±0.5),(2.4±0.6) vs.(3.3±0.7),F=29.670 0,P ＜ 0.000 1] and venipuncture acceptance score [(1.9±0.6),(2.1±0.7) vs.(3.2±0.8),F=35.190 0,P ＜ 0.000 1] were both higher in group C.Compared with group A and group B,the anesthesia induction time [(69.8±5.7) s,(72.3±6.8) s vs.(53.6±4.9) s,F=113.900 0,P ＜ 0.000 1],anesthetic revival time [(15.3±2.9) min,(13.5±2.6) min vs.(8.3±1.9) min,F=77.910 0,P ＜ 0.000 1] and the score of postoperative agitation [(2.9±0.7),(3.1±0.6) vs.(1.6±0.7),F=56.920 0,P ＜ 0.000 1;(2.3±0.6),(2.5±0.7) vs.(1.5±0.6),F=26.530 0,P ＜ 0.000 1;(2.1±0.4),(2.3±0.5) vs.(1.3±0.3),F=64.130 0,P ＜ 0.000 1] were both lower (P ＜ 0.05) in group C.The rate of intranasal stimulus in group B and group C were both lower than that of group A (0.0％,10.0％ vs.40.0％,x 2=18.720 0,P ＜ 0.000 1).Conclusions Intranasal administration of Dex (2.0 μg/kg) can provide satisfactory preoperative sedation and analgesia for children undertaking occlusion of ventricular septal defect,and lower the rate of postoperative agitation.%目的 观察右美托咪定(Dex)术前喷鼻在小儿室间隔缺损封堵术前镇静镇痛及术后躁动的影响.方法 择期行室间隔缺损封堵术的患儿共90例,年龄2～6岁,采用随机数字表法分成3组,每组30例.A、B和C组分别于麻醉诱导前30 min以咪达唑仑0.2 mg/kg、Dex 1.0μg/kg或2.0μg/kg喷鼻.记录3组基础值(T0)、给药后5 min(T1)、给药后15 min(T2)、给药后25min(T3)、麻醉诱导后10 min(T4)、手术开始后30min(T5)、术毕(T6)及术后30 min(T7)时的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)及脑电双频指数(BIS).于T0～3时对3组患儿进行警觉与镇静评分(OAA/S评分),记录3组患儿与家长分离时镇静情绪评分和静脉穿刺接受程度评分.记录3组患儿术后躁动评分及其他不良反应发生率.结果 与A组比较,C组T2～3时OAA/S评分[(5.6±0.7)vs.(4.5±0.9),F=24.43,P＜0.0001;(4.8±0.7)vs.(3.5±1.0),F=36.67,P＜0.0001]均降低,且T2～3、T6～7时HR、MAP及BIS均降低(P＜0.05).与A组和B组比较,C组患儿与家长分离时镇静情绪评分[(2.3±0.5)、(2.4±0.6)vs.(3.3±0.7),F=29.67,P＜ 0.000 1]及静脉穿刺接受程度评分[(1.9±0.6)、(2.1±0.7)vs.(3.2±0.8),F=35.19,P＜ 0.000 1]均升高,而麻醉诱导时间[(69.8±5.7)s、(72.3±6.8)s vs.(53.6±4.9)s,F=113.9,P＜0.000 1]、苏醒时间[(15.3±2.9)min、(13.5±2.6) min vs.(8.3±1.9) min,F=77.91,P＜0.000 1]和术后躁动评分[(2.9±0.7)、(3.1±0.6) vs.(1.6±0.7),F=56.92,P＜0.000 1;(2.3±0.6)、(2.5±0.7) vs.(1.5±0.6),F=26.53,P＜0.000 1;(2.1±0.4)、(2.3±0.5)vs.(1.3±0.3),F=64.13,P＜ 0.000 1]均减少.B组和C组患儿喷鼻刺激发生率均低于A组(0.0％、10.0％ vs.40.0％,x2=18.720,P＜ 0.000 1).结论 Dex (2.0μg/kg)术前喷鼻用于小儿室间隔缺损封堵术能提供更为满意的术前镇静效果,发挥较好的术后镇静和镇痛效应,并更有效地降低术后躁动的发生率.