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右美托咪定静脉泵注和鼻内给药两种方式对小儿口腔日间手术术后躁动的影响 预览

Comparison of intranasal dexmedetomidine and intravenous dexmedetomidine for prevention of emergence agitation after ambulatory orthognathic surgery in children
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摘要 目的比较右美托咪定静脉泵注和鼻内给药两种方法对七氟烷吸入麻醉下小儿口腔日间手术术后躁动的影响。方法随机纳入135例拟行口腔日间手术的患儿,年龄1~6岁,分为3组,每组45例,分别予麻醉诱导后右美托咪定1μg/kg静脉泵注(VD组)、麻醉诱导前15 min右美托咪定1μg/kg鼻内给药(ND组)或等量生理盐水对照(C组)。所有患儿采用七氟烷全凭吸入麻醉。术后每5 min进行一次躁动评分(PEDA)及疼痛评分(FLACC);记录麻醉诱导前(T0)、麻醉诱导后(T1)、手术开始时(T2)、手术结束时(T3)及苏醒时(T4)的HR、BP;记录苏醒时间、PACU停留时间及恶心呕吐、呼吸抑制、心动过缓等不良反应发生情况。结果 VD组和ND组术后躁动发生率明显低于C组(P〈0.01);T2和T3时VD组心率明显低于ND组和C组(P〈0.01),T3时ND组心率低于C组(P〈0.05);VD组和ND组苏醒时间长于C组(P〈0.01);3组患儿PACU停留时间没有差异;3组患儿最高疼痛评分没有差异。VD组有4例患儿出现心动过缓需使用阿托品治疗。3组患儿均未发生其他严重不良反应。结论右美托咪定静脉泵注和鼻内给药都能明显降低七氟烷麻醉后躁动的发生,右美托咪定鼻内给药对心率影响更小。 Objective To compare the effects of intranasal dexmedetomidine and intravenous dexmedetomidine on emergence agitation(EA) after sevoflurane anaesthesia in pediatric ambulatory orthognathic surgery. Methods In this study,135 children,1-6 years of age,undergoing sevoflurane anaesthesia were assigned to three groups which receiving either intravenous dexmedetomidine 1 μg/kg after induction(Group VD),intranasal dexmedetomidine 1 μg/kg 15 min before induction(Group ND),or saline(Group C). The severity of EA were evaluated with the Paediatric Anaesthesia Emergence Delirium(PAED) scale and pain were evaluated with FLACC scale every 5 min after surgery. The HR and BP were record at time points:before induction(T0),after induction(T1),beginning of surgery(T2),being operated(T3)and woke up(T4). And the time to recovery and PACU stays,incidence of nausea/vomiting,breath depression and bradycardia were assessed. Results The incidence of EA in Group VD and Group ND were lower than Group C(P0.01). The HR at time T2 and T3 in Group ND was significantly lower than that in Group VD and Group C(P0.01),and the HR at time T3 was lower in Group ND than Group C(P0.05). Recovery time in Group ND and Group VD weres longer than in Group C(P0.01). The differences in time of PACU stays and the highest pain score between the 3 groups were considered clinically insignificant. Four children in Group VD required atropine treatment for bradycardia. Conclusion Both intranasal dexmedetomidine and intravenous dexmedetomidine comparably reduced EA after sevoflurane anaesthesia in pediatric pediatric ambulatory orthognathic surgery. Intranasal dexmedetomidine provide more acceptable heart rate during the surgery.
作者 雷东旭 潘永英 陈柳妹 王怀贞 赵晴 宋兴荣 LEI Dongxu,PAN Yongying,CHEN Liumei,WANG Huaizhen,ZHAO Qing,SONG Xingrong(Department of Anesthesiology,Guangzhou Women and Children Medical Center,Guangzhou 510623,China)
出处 《岭南现代临床外科》 2018年第3期345-348,共4页 Lingnan Modern Clinics in Surgery
关键词 右美托咪定 术后躁动 七氟烷 日间手术 dexmedetomidine emergence agitation sevoflurance ambulatory surgery
作者简介 通讯作者:雷东旭,Email:kaluleidongxu@163.com
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