右美托咪定2种给药方式对小儿苏醒期的影响

目的比较右美托咪定经鼻与静脉给药2种给药方式对七氟醚吸入全身麻醉下腹腔镜腹股沟疝结扎术患儿苏醒期的影响。方法选择中国科学技术大学附属第一医院择期腹腔镜腹股沟疝结扎术患儿90例,随机分为3组:静脉给药(VD组),经鼻给药组(ND组)和对照组(C组),每组各30例。麻醉诱导前VD组患儿静脉泵注右美托咪定0.5μg/kg,ND组患儿经鼻滴入右美托咪定2.0μg/kg,C组患儿使用生理盐水。记录各组患儿手术时间、喉罩拔除时间及PACU逗留时间。采用患儿麻醉苏醒期躁动量表(PAED)和Ramsay镇静评分评估各组患儿苏醒后5、15、30 min的镇静程度。记录患儿术前、手术开始10 min、手术结束时患儿血压、心率、氧饱和度及用药后的不良反应。结果手术及PACU逗留时间3组间差异无统计学意义(P>0.05)。与C组比较,患儿苏醒后5、15、30 min VD组和ND组PAED值评分显著降低,患儿术后躁动显著减少(均P<0.05)。患儿苏醒后各时间点Ramsay值C组低于VD组和ND组(均P<0.05)。手术后10 min与手术结束时VD组心率下降高于ND组和C组(均P<0.05),但仍在安全范围内。3组患儿均未发生呼吸抑制。结论对于腹腔镜腹股沟疝结扎术患儿,使用右美托咪定经鼻与静脉给药均可以提供良好的镇静抗焦虑作用,但是经鼻给药较静脉给药对患儿心率的影响较小。

Impact of different routes of administrations of dexmedetomidine on children during the process of recovery from anesthesia

Objective To compare the impacts of intranasal and intravenous administration of dexmedetomidine on the process of recovery from general anesthesia with sevoflurane inhalation in pediatric patients undergoing laparoscopic inguinal hernia ligation. Methods A total of 90 patients undergoing laparoscopic inguinal hernia ligation in the First Affiliated Hospital of University of Science and Technology of China between October 2017 to December 2018 were randomly divided into intravenous administration group (VD group), intranasal administration group (ND group), and control group (C group), with 30 cases in each group. Before anesthesia Induction, the VD group received intravenous administration of dexmedetomidine (0.5 μg/kg) combined with intranasal administration of 0.5 mL saline; The ND group received intravenous administration of 0.5 mL saline combined with intranasal administration of dexmedetomidine (2.0 μg/kg); The C group received intravenous administration of 0.5 mL saline combined with intranasal administration of dexmedetomidine (2 μg/kg). The operation time, the time to extraction of laryngeal mask and the time stay in recovery room were recorded. The Pediatric anesthesia Emergence Delirium Scale (PAED) score and Ramsay score were used to evaluate the levels of sedation at 5 min, 10 min and 30 min after waking up. The blood pressure, heart rate, oxygen saturation and adverse reactions of patients were also recorded before surgery, 10 min after surgery, and at the end of the surgery. Results There were no significant differences in the operation time and PACU stay time among the three groups. The PAED scores in group C were higher than group VD and group ND at 5 min, 15 min and 30 min after the patients waking up (all P＜0.05), and the levels of sedation in VD and ND decreased. The Ramsay scores of group C were lower than group VD and group ND (all P＜0.05). The heart rate at 10 min after surgery and the end of surgery in VD group decreased more obviously as compared with ND group and C group (all P＜0.05), but still within the safe range. No respiratory depression occurred in all the three groups. Conclusion Administration of dexmedetomidine via venous and nasal can provide a satisfactory sedation and delirium effect for children with laparoscopic hernia surgery. Intranasal administration of dexmedetomidine had fewer side effects on heart rate as compared with intravenous administration.