目的：比较小儿神经外科手术前使用不同剂量右美托咪定滴鼻的镇静效果。方法择期行开颅手术患儿40例，ASA 分级Ⅱ级，随机分为右美托咪定2μg/ kg 组（D2组，n =20）和右美托咪定3μg/ kg 组（D3组，n =20），于术前30 min 分别给予右美托咪定2μg/ kg 或右美托咪定3μg/ kg 滴鼻。记录用药前及用药后10 min、20 min、30 min 的Ramsay 镇静评分、心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2），评估患儿用药后镇静起效时间、离开父母时镇静程度、开放外周静脉时行为学反应和术毕苏醒时间。结果与 D2组相比，D3组患儿更易入睡、离开父母时的 Ramsay评分较高[5（5-5），P ﹤0.01]、开放外周静脉时的行为学评分较高[3.0（3-4），P ﹤0.01]。给药前和给药后10 min、20 min、30 min 两组 MAP 和 HR 差异无统计学意义。术毕清醒时间两组差异无统计学意义。结论右美托咪定3μg/ kg滴鼻可使患儿在与父母分离时达到更为满意的镇静水平，行外周静脉穿刺时耐受性更好，且给药后血流动力学平稳、无呼吸抑制，不延长开颅术后患儿的苏醒时间。%Objective This prospective,randomized,double - blind study was designed to evaluate sedative effects of different doses of intranasal dexmedetomidine for premedication in children undergoing craniotomy. Methods Forty children of American Society of Anesthesiology (ASA)physical status classification II,aged 2 ~ 7 years,were randomly assigned to one of two groups. Group D2 received intranasal dexmedeto-midine(2 μg/ kg,n = 20),and group D3 received intranasal dexmedetomidine(3 μg/ kg,n = 20). The patients' sedation status( Ramsay scores),HR,MAP and SpO2 were recorded before and every 10 min after intranasal drug administration until transfer to the operating room. The sedation onset time,sedation status at separation from the parent,intravenous cannulation acceptance,and postoperative awakening time were also recorded. Results Compared with the children in group D2,those in group D3 were significantly more sedated when they were separated from their parents(Ramsay scores 5,P ﹤ 0. 01). Children from groups D3 had high behavior scores 3. 0(3 ~ 4)( P ﹤ 0. 01)at the time of cannula-tion. There was no significant difference between the two groups regarding the hemodynamic parameters and postoperative awakening time. Conclu-sion The higher dose of intranasal dexmedetomidine(3 μg/ kg)provides better sedative effect without hemodynamic depression for those children undergoing craniotomy.
展开▼
