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右美托咪定滴鼻在小儿扁桃体摘除术中的临床观察
作者:孙振微  陆学芬  林欣  沈苓  杭黎华 
单位:昆山市第一人民医院 麻醉科, 江苏 昆山 215300
关键词:右美托咪定 滴鼻 扁桃体摘除术 
分类号:R766
出版年·卷·期(页码):2017·36·第十二期(1724-1727)
摘要:

目的:观察右美托咪定滴鼻在小儿扁桃体摘除术中应用的临床效果。方法:择期行扁桃体摘除术患儿30例,随机分为右美托咪定1.0 μg·kg-1组(D组)和生理盐水组(NS组),每组15例,分别在麻醉诱导前30 min右美托咪定1 μg·kg-1或等量生理盐水滴鼻,记录患儿开放静脉通路时、与父母分离时镇静评分,拔管时躁动评分,恢复室5 min躁动评分。记录滴鼻前(T0,基础状态)、滴鼻后30 min (T1)、诱导插管时(T2)、拔管时(T3)、拔管后5 min (T4)心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、脉搏氧饱和度(SpO2)及两组患儿拔管时间。结果:D组患儿T1~T4时HR低于T0(P<0.05),NS组T2、T3时HR高于T0(P<0.05)。D组T1~T4时患儿HR较NS组低,差异具有统计学意义(P<0.05)。两组患儿与父母分离时镇静评分、拔管时躁动评分、恢复室5 min躁动评分差异具有统计学意义(P<0.05)。结论:右美托咪定1.0 μg·kg-1术前滴鼻可安全有效地用于小儿扁桃体摘除术,术前提供良好镇静,术后预防苏醒期躁动。

Objective: To observe the clinical effects of intranasal dexmedetomidine in pediatric tonsillectomy.Methods: Thirty children undergoing tonsillectomy were randomly divided into dexmedetomidine 1.0μg·kg-1 group(D group) and normal saline group(NS group). They received intranasal dexmedetomidine 1.0 μg·kg-1 or normal saline 30 munites before anesthesia induction. The sedation score of placement of Ⅳ cannula and parental separation were recorded,the agitation score at tracheal extubation and at five minutes after PACU were recorded too. The changes of HR,MAP,RR,SpO2 were recorded before intranasal administration(T0, baseline), 30 minutes after intranasal administration(T1), at the time of intubation (T2), at the time of extubation (T3) and 5 minutes after extubation (T4).Results: The HR in group D at T1-T4 were lower than those at T0. The HR in group NS at T2,T3 were higher than those at T0. The HR in group D were lower than those in group NS at T1-T4,and there were statistically significant(P<0.05).The sedation score at parental separation,the agitation score at tracheal extubation and at five minutes after PACU were different between the two groups,and there were statistically significant(P<0.05)Conclusion: Intranasal dexmedetomidine before anesthesia induction may provide a safe and good sedation effect for chidren undergoing tonsillectomy,and can prevent emergence agitation.

参考文献:

[1] MCNG Q T,XIA Z Y,LUO T,et al.Dexmedetomidine reduces emergence agitation after tonsillectomy in children by sevoflurane anesthesia:a case-control study[J].Int J Pediatr Otorhinolaryngol,2012,76(7):1036-1041.
[2] ZUB D,BERKENBOSCH J W,TOBIAS J D.Preliminary experience with oral dexmedetomidine for procedural and anesthetic premedication[J].Pediatric Anesthesia,2005,15(11):932-938.
[3] JUN J H,KIM K N,KIM J Y,et al.The effects of intranasal dexmedetomidine premedication in children:a systematic review and meta-analysis[J].Can J Anaesth,2017,6:21.
[4] EI-HAMID A M A,YASSIN H M.Effect of intranasal dexmedetomidine on emergence agitation after sevoflurane anesthesia in children undergoing tonsillectomy and/or adenoidectomy[J].Saudi J Anaesth,2017,11(2):137-143.
[5] 贾继娥,陈佳瑶,胡潇,等.白内障手术患儿右美托咪定术前滴鼻的镇静效果[J].临床麻醉学杂志,2012,28(12):1172-1174.

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