目的 观察右美托咪定滴鼻对小儿术前镇静的安全性及有效性.方法 择期行腺样体或伴有扁桃体切除术患儿90例,年龄2~7岁,美国麻醉医师协会(American Society Anesthsiologists,ASA)分级Ⅰ级.按随机数字表法将90例患儿分成3组,每组30例.七氟醚麻醉诱导前30 min,分别经鼻滴入右美托咪定1.0 μg/kg(D1组)、右美托咪定0.5 μg/kg(D2组)及等容积生理盐水(NS组).记录患儿给药前的基础情绪,给药后鼻腔不适感的发生情况,同时监测给药即刻至入手术室前患儿的脉搏、血压、血氧饱和度,记录患儿给药后30 min的镇静评分、情绪评分、与父母分离抵抗评分、静脉穿刺抵抗评分、面罩抵抗评分及不良反应发生情况.结果 D1组、D2组患儿的镇静评分、情绪评分、与父母分离评分、静脉穿刺抵抗评分、面罩抵抗评分均高于NS组,差异有统计学意义(P<0.05);D1组的面罩抵抗评分高于D2组,差异有统计学意义(P<0.05).三组患儿围术期血压、心率、血氧饱和度波动和不良反应发生情况比较差异无统计学意义(P>0.05).结论 经鼻应用右美托咪定对小儿术前有镇静作用,面罩吸入诱导时,右美托咪定1.0 μg/kg的镇静效果优于0.5 μg/kg,且对循环呼吸无影响.%Objective To investigate the preoperative sedation effect of intranasal dexmedetomidine in children.Methods Ninety children (ASA Ⅰ,2～7 years old) undergoing elective tonsillectomy with or without adenoidectomy were randomly assigned into group D1(n=30,intranasal dexmedemidine 1.0 μg/kg),group D2(n=30,intranasal dexmedemidine 0.5 μg/kg) and group NS(n=30,intranasal normal saline).Heart rate (HR),blood pressure (BP),hemoglobin oxygen saturation (SpO2) were monitored before intranasal administration to the start of operation.The scores of sedation,mood,behaviour at separation from parents,venepuncture and masking resistance were recorded and the adverse effects were observed.Results The sedation,mood,behaviour at separation from parents,venepuncture and masking resistance scores of group D1 and group D2 were higher than those of group NS (P<0.05).The masking resistance score of group D1 was higher than that of group D2(P<0.05).There was no significant difference in hemodynamic and respiratory variables and adverse effects among three groups (P>0.05).Conclusion Preoperative intranasal dexmedetomidine can definitely sedate children,dexmedetomidine 1.0 μg/kg is better than 0.5 μg/kg,and doesnot affect hemodynamics and respiratory variables.
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