| 摘要: |
| 目的：探讨不同剂量右美托咪定（Dex）术前给药在鼻内镜下腺样体切除术患儿中的疗效及安全性。方法：选取2019年1月至2020年6月期间于唐山市妇幼保健院行腺样体切除术的120例患儿为研究对象，按照随机数字表法分为3组各40例。入室前60 min给予不同剂量的Dex滴鼻，A组剂量1 μg/kg，B组剂量2 μg/kg，C组剂量3 μg/kg，比较3组患儿滴鼻前（T0）及滴鼻10 min（T1）、30 min（T2）、60 min（T3）时血流动力学指标，包括心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2），术前镇静效果（镇静起效时间、镇静评分、分离抵抗评分、建立静脉通路行为学反应评分），术后麻醉苏醒时间（呼吸恢复时间、拔管时间、苏醒时间、定向力恢复时间）及术后不良反应。结果：HR、MAP、SpO2组间、各时间点间、组间×时间点比较，差异均无统计学意义（P>0.05）；3组镇静起效时间、镇静评分、分离抵抗评分、建立静脉通路行为学反应评分比较差异均有统计学意义（F值分别为30.18、10.37、9.18、23.05，P<0.05）；三组术后呼吸恢复时间、拔管时间比较差异均无统计学意义（P>0.05），苏醒时间、定向力恢复时间比较差异均有统计学意义（F值分别为3.85、29.41，P<0.05）；不良反应总发生率A组5.00%，B组7.50%，C组12.50%，组间比较差异无统计学意义（P>0.05）。结论：小儿鼻内镜下腺样体切除术术前经经鼻滴入2 μg/kg Dex是相对安全有效的，可产生较好的镇静效果，且术后不良反应较小，可作为该类小儿手术术前麻醉的推荐剂量。 |
| 关键词: 右美托咪定 腺样体切除术 血流动力学 镇静效果 苏醒期躁动 |
| DOI：doi:10.13407/ j.cnki.jpp.1672.108X.2022.04.011 |
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| 基金项目: |
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| Application and Safety of Preoperative Administration of Different Doses of Dexmedetomidine in Children Undergoing Endoscopic-Assisted Transoral Adenoidectomy |
| Yang Hongyuan1, Yin Jing1, Li Yuanyuan1, Li Kunpeng2, Zhao Yuankui2, Bai Yaowu |
| (1. Tangshan Maternal and Child Health Care Hospital, Hebei Tangshan 063000, China; 2. The Second People's Hospital of Fengrun District, Hebei Tangshan 063000, China) |
| Abstract: |
| Objective: To analyze the application and safety of preoperative administration of different doses of dexmedetomidine (Dex) in children undergoing endoscopic-assisted transoral adenoidectomy. Methods: A total of 120 children who underwent adenoidectomy in the Tangshan maternal and child Health Care Hospital between January 2019 and June 2020 were selected as the research subjects, and they were divided into three groups with 40 cases in each group according to the random number table method. The children were given different concentrations of dex through the nasal cavity at 60min before entering the room, and group A, group B and group C were given nasal drops of 1 μg/kg, 2 μg/kg and 3 μg/kg respectively. The hemodynamic indicators [heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO2)] before nasal drop (T0) and at 10 min (T1), 30 min (T2) and 60 min (T3) of nasal drip, preoperative sedative effect (sedation onset time, sedation score, separation resistance score, behavioral response score of venous access establishment), postoperative anesthesia recovery time (respiratory recovery time, extubation time, awakening time, orientation recovery time) and postoperative adverse reactions were compared among the three groups. Results: There were no statistically significant differences in the between-group effect, time-point effect and interaction effect of between-group×time-point of HR, MAP and SpO2 (P>0.05). There were statistically significant differences in the sedation onset time, sedation score, separation resistance score and behavioral response score of venous access establishment among the three groups (F=30.18, 10.37, 9.18 and 23.05, all P<0.05). There were significant differences in postoperative respiratory recovery time and extubation time among the three groups (P>0.05), and there were statistical differences in awakening time and orientation recovery time (F=3.85, 29.41, both P<0.05). The total incidence rate of adverse reactions was 5.00% in group A, 7.50% in group B and 12.50% in group C. Conclusion: Nasal drop of 2 μg/kg Dex before endoscopic-assisted transoral adenoidectomy in children is relatively safe and effective, and can produce good sedative effect, and has fewer adverse reactions after surgery. It can be used as the recommended dose of preoperative anesthesia in children with this type of surgery. |
| Key words: dexmedetomidine adenoidectomy hemodynamics sedative effect emergence agitation |
