不同剂量右美托咪定术前滴鼻对扁桃体摘除术患儿安全性的影响

目的 观察不同剂量右美托咪定术前滴鼻对扁桃体摘除术患儿安全性的影响。 方法 行扁桃体摘除术的患儿60例(ASAⅠ级),随机分到高剂量H组、低剂量L组和对照C组,每组20例,麻醉诱导前40 min,H组鼻腔滴入2 μg/kg右美托咪定(加生理盐水至0.3 mL),L组鼻腔滴入1 μg/kg右美托咪定(加生理盐水至0.3 mL),C组鼻腔滴入0.3 mL生理盐水。观察三组患儿用药后镇静、分离状态、血流动力学、呼吸、拔管时间、PACU停留时间、不良事件发生情况,并监测不同时点血清炎性因子TNF-α和IL-6水平。结果 H组和L组的术前镇静及分离状态明显优于C组,C组患儿心率和血压随时间变化明显,且高于H组和L组(P<0.001),三组患儿各时间点血氧饱和度及拔管时间、PACU停留时间的差异无统计学意义(P>0.05);H组和L组的患儿呛咳、术后躁动的发生率明显低于C组(P=0.024, P=0.025);H组和L组在拔管后即刻、术毕4 h、12 h和24 h的TNF-α、IL-6血浆浓度均低于C组(P<0.001)。 结论 右美托咪定术前滴鼻能提高患儿镇静水平,改善亲子分离状态,血流动力学平稳,无呼吸抑制,不影响拔管时间,降低不良事件发生,减少围术期炎性因子释放,增加安全性;且使用2 μg/kg剂量较1 μg/kg更能维持循环稳定,降低炎性因子释放。

Effect of different doses of dexmedetomidine preoperative intranasal medication on the safety in children tonsillec-tomy

Objective To observe the safety effect of different doses of dexmedetomidine preoperative intranasal medi-cation in children tonsillectomy.Methods Sixty children for tonsillectomy were randomly assigned into the H,L and C groups (n =20).Group H was given dexmedetomidine 2 μg /kg (adding saline to 0.3 mL),group L was given dexmedetomidine 1 μg /kg (adding saline to 0.3 mL)and group C was given physiological saline 0.3 mL,40 min before the induction of anesthesia,respectively.The sedation,separated state,hemodynamics,breath,extubation time,PACU stay,as well as side effects were observed among groups.The serum levels of inflammatory cytokine TNF-αand IL-6 after extubation immediately (T1 ),postoperative 4 h (T2 ),postoperative 12 h (T3 )and postoperative 24 h (T4 )were measured,respectively.Results The sedation and separated state in groups H and L were much better than those in group C.BP and HR in groups H and L were lower than those in group C at different time points (P <0.001).Oxygen saturation,extubation time and PACU stay time showed no significant difference among groups (P >0.05).The incidences of adverse events in groups H and L,such as postoperative agitation and choking cough,were lower than those in group C (P =0.024 &P =0.025).The plasma levers of TNF-αand IL-6 in groups H and L were lower than those in group C (P <0.001)at T1 ,T2 ,T3 and T4 .Conclusion Dexmedetomidine preoperative intranasal medication can improve children sedation level,improve parent-child separation state,maintain stable hemodynamics with no respiratory depression and less adverse events,reduce perioperative inflammatory factor release,and increase security.Dexmedetomidine 2 μg /kg provides more stable circulation by reducing inflammatory cytokine release.