右美托咪定滴鼻用于小儿腹腔镜疝囊高位结扎术的临床观察

Intranasal administration of dexmedetomidine in pediatric patients undergoing laparoscopic high ligation for incarcerated inguinal hernia

关键词:  右美托咪定  诱导期合作  苏醒期躁动  出院后行为改变

Key words:  dexmedetomidine  induction compliance  emergence delirium  post hospitalization behavior change

摘要:

目的探讨不同剂量右美托咪定（dexmedetomidine, Dex)滴鼻对腹腔镜疝囊高位结扎术小儿的影响。方法选取90例拟行腹腔镜疝囊高位结扎术患儿，随机分为3组（A组、B组和C组），每组30例。麻醉诱导前30min，A组经鼻滴入右美托咪定（1μg/kg），B组经鼻滴入右美托咪定（2μg/kg），C组为经鼻滴入等量生理盐水。记录患儿滴鼻前即刻（T0）、滴鼻后10min（T1）、滴鼻后20min（T2）、麻醉诱导时（T3）、手术开始时（T4）、拔出喉罩时（T5）的心率（heart rate, HR)、平均动脉压（mean arterial pressure, MAP)和血氧饱和度(saturation pulse oxygen, SpO2)，以及麻醉时间、手术时间、诱导期合作表（induction compliance checklist, ICC)评分、儿童苏醒期躁动量表（pediatric anesthesia emergence delirium, PAED）评分、出院后行为问卷（post hospitalization behavior questionnaire, PHBQ）例数和不良反应的发生。结果与A组、C组相比，B组T2、T4、T5时MAP，T2～T5时HR显著下降（P<0.05）。与C组相比，A组和B组ICC评分、PAED评分、PHBQ例数显著下降（P<0.05）。三组患儿一般资料、麻醉时间、手术时间、SpO2及不良反应发生的差异无统计学意义。结论右美托咪定滴鼻用于小儿腹腔镜疝囊高位结扎术，可显著提高麻醉诱导合作度，降低苏醒期躁动和出院后行为改变的发生。术前滴鼻右美托咪定1μg/kg与2μg/kg对MAP和HR影响较小。

Abstract:

ObjectiveTo investigate the effects of intranasal administration of dexmedetomidine in pediatric patients undergoing laparoscopic high ligation for incarcerated inguinal hernia. MethodsNinety children undergoing laparoscopic high ligation for incarcerated inguinal hernia were randomly divided into 3 groups with 30 cases in each group. The dexmedetomidine 1μg/kg, dexmedetomidine 2μg/kg or the same volume of normal saline was intranasally administered 30 min before anesthesia induction in groups A, B, C, respectively. HR, MAP and SpO2 were recorded before (T0),10 min (T1) and 20 min after (T2) administration, at the time of induction of anesthesia (T3), at the beginning of surgery (T4), and at the time of removal of the laryngeal mask (T5). Anesthesia time, operation time, induction compliance checklist (ICC), pediatric anesthesia emergence delirium (PAED), post hospitalization behavior questionnaire (PHBQ) and the incidence of adverse events were documented. ResultsCompared with group A and group C, MAP in group B decreased significantly at T2, T4 and T5, HR decreased significantly at T2～T5（P<0.05）. Compared with group C, the ICC score, PAED score and PHBQ cases in group A and group B decreased significantly (P<0.05）. There were no significant differences in general information, anesthesia time, operation time, SpO2 and adverse events among the three groups. ConclusionIntranasal administration of dexmedetomidine can increase anesthesia induction compliance, decrease emergence delirium and post hospitalization behavior change in pediatric patients undergoing laparoscopic high ligation for incarcerated inguinal hernia. Compared with dose of 2μg/kg, 1μg/kg dexmedetomidine intranasally administered has less effect on MAP and HR.