右美托咪定非静脉给药对下腹部及下肢手术患儿的镇静效果

目的：探讨右美托咪定（DEX）非静脉给药在儿科下腹部及下肢手术中的应用，观察DEX在该类手术中的镇静效果。方法：选择全身麻醉下行下腹部及下肢手术的患儿60例，随机分为罗骶组、DEX鼻组和DEX骶组，每组20例。DEX鼻组患儿于术前30min给予DEX 1μg·kg^-1滴鼻，另2组患儿给予等容积生理盐水滴鼻。30min后不能顺利转入手术室及诱导时不能耐受面罩或七氟醚的患儿给予丙泊酚1mg·kg^-1。罗骶组和DEX鼻组患儿行骶管阻滞注入0.25%罗哌卡因1mL·kg^-1，DEX骶组患儿给予0.25%罗哌卡因1mL·kg^-1+DEX 1μg·kg^-1，药物总量20 mL。记录患儿的一般资料、离开父母时的镇静评分、诱导期面罩和七氟醚接受评分；记录患儿离开父母的满意度、面罩吸氧和七氟醚吸入的接受满意度；记录麻醉诱导时间、手术时间、拔喉罩时间和苏醒时间；记录苏醒期喉痉挛、苏醒延迟及苏醒躁动评分；记录麻醉恢复评分及丙泊酚的用量；记录术后4、8、12、16、20和24h时的镇静评分。结果：DEX鼻组患儿与父母分离时的镇静评分、面罩诱导和七氟醚接受评分、患儿家属分离满意度、面罩和七氟醚接受满意度均高于罗骶组和DEX骶组（P<0.05），丙泊酚用量低于罗骶组和DEX骶组（P<0.05）。3组患儿手术时间、拔喉罩时间和苏醒时间比较差异无统计学意义（P>0.05），DEX鼻组患儿诱导时间短于罗骶组和DEX骶组（P<0.05）。3组患儿均无苏醒延迟发生，罗骶组患儿喉痉挛和躁动评分明显高于DEX鼻组和DEX骶组（P<0.05）。3组患儿麻醉后意识、呼吸、活动评分和麻醉恢复评分比较差异无统计学意义（P>0.05）。3组患儿术后4 h时镇静评分均小于3分，DEX鼻组和DEX骶组8 h时的镇静评分明显低于罗骶组（P<0.05），DEX骶组12、16和20h时的镇静评分明显低于罗骶组和DEX鼻组（P<0.05），3组患儿术后24 h时镇静评分比较差异无统计学意义（P>0.05）。结论：DEX非静脉给药应用于儿科下腹部及下肢手术时患儿可以安静合作地进入手术室，快速平稳完成诱导过程，苏醒躁动发生概率明显降低，有早期术后镇静的作用。

Sedative effect of non-intravenous administration dexmedetomidine in pediatric patients underwent lower abdomen and limb surgery

Objective:To investigate the application of non-intravenous dexmedetomidine(DEX)in the pediatric patients underwent lower abdomen and limb surgery,and to observe the sedative effect of DEX in this procedure. Methods:Sixty patients undergoing the general anesthesia for lower abdomen and limb surgery were selected and randomly devided into ropivacaine sacral block(RS)group,intranasal DEX+ ropivacaine sacral block(ID)group, ropivacaine + DEX sacral block(DS)group,20 cases in each group.The children in ID group received intranasal DEX 1 μg·kg-130 min before operation and the children in RS and DS groups received physiological saline. 1 mL·kg-1propofol was infused intravenously in the children who could not smoothly enter into the operating room as well as the intolerance to oxygen mask or sevoflurane inhalation while induction.The children in RS and ID groups received 0.25% ropivacaine 1 mL·kg-1,and the children in DS group received the same dose of ropivacaine mixed with 1 μg·kg-1DEX,and the total volume of drugs was 20 mL.The general information of each child was recorded;the sedation status when separated from their parents and induction period mask and sevoflurane acceptance scores were assessed;the satisfaction of separation with parents,oxygen mask and sevoflurane inhalation were recorded;the time of operation,induction,extraction of laryngeal mask and anesthesia awake were recorded;delayed awakening,laryngismus and awakening period agitation score were recorded.The scores of anesthesia recovery and the dosage of propofol were recorded;the sedation scores 4,8,12,16,20,and 24 h after operation were recorded.Results:Compared with RS and DS groups,the sedation scores of the children when they were separated from their parents and mask induction and sevoflurane inhalation acceptance,the satisfaction degree of separation,mask and sevoflurane acceptance in ID group were increased(P<0.05);the dosage of propofol in ID group were decreased(P<0.05).The time of operation,extraction of laryngeal mask and anesthesia awake had no significant differences between three groups(P>0.05),the induction time of children in ID group was shorter than those in RS and DS groups(P<0.05).There was no delayed awakening in three groups,and the laryngismus and the awakening period agitation score in RS group were higher than those in ID and DS groups(P<0.05).There was no differences in the consciousness,respiration,activity scores and the scores of anethesia recovery between three groups(P>0.05).The sedation scores in the three groups were less than 3 points 4 h after operation. Compared with RS group,the sedation scores in ID and DS groups were decreased 8 h after operation(P<0.05). Compared with RS and ID groups,the sedation scores in DS group 12,16 and 20h after operation were decreased (P<0.05).There were no significant differences in the sedation scores between three groups 24 h after operation (P>0.05).Conclusion:When non-intravenous DEX is used in the pediatric patients underwent lower abdomen and limb surgery,the children can quietly and co-operationly enter into the operating room and quickly and smoothly complete the induction process;the incidence of revival restlessness is significantly reduced,and it can play a role in the early postoperative sedation.