鼻喷右美托咪定在儿童口腔门诊全身麻醉前的镇静效果

doi:10.19723/j.issn.1671-167X.2018.06.024

摘要/Abstract

摘要：

目的: 观察全身麻醉下牙病治疗患儿鼻喷右美托咪定(dexmedetomidine,DEX)对术前紧张情绪、父母分离焦虑、面罩接受程度和术后躁动的影响。方法: 选择北京大学口腔医院儿童口腔门诊全身麻醉下牙病治疗的患儿60例,年龄2~9岁,随机分为2组:对照组术前30 min经鼻喷入生理盐水0.02 mL/kg,DEX组喷入DEX 2 μg/kg(药物使用原液)。观察和记录患儿给药前及给药后10、20、25、30 min的心率(heart rate,HR)、脉搏血氧饱和度(oxygen saturation,SpO₂)以及给药30 min后的Ramsay镇静评分、分离焦虑评分、面罩吸入诱导接受度评分和术后躁动评分及并发症的情况。结果: 两组患儿的年龄、体重、性别构成、手术时间、拔管时间和苏醒时间相似,差异无统计学意义。DEX组患儿与父母的分离焦虑、面罩接受程度明显优于对照组(56.7% vs. 26.7%,73.3% vs. 40%,P均<0.05),术后躁动评分在两组间差异无统计学意义(P>0.05)。与对照组相比,DEX组患儿给药20 min后HR有所下降,差异有统计学意义[(97.13±12.93)次/min vs. (104.53±11.97)次/min, P<0.05]。两组患儿的SpO₂未见明显差异,且均未见心动过缓、低氧血症的发生。结论: 全身麻醉前经鼻喷入DEX可以产生良好的术前镇静作用,改善与父母的分离焦虑,提高面罩接受度。两组患儿苏醒质量高,无明显的苏醒期躁动、呼吸抑制等并发症。鼻喷DEX 2 μg/kg是一种安全有效的儿童术前给药方式。

关键词: 右美托咪定, 给药, 鼻内, 清醒镇静, 手术前护理, 儿童

Abstract:

Objective: To observe the preoperative sedation, the status of separation from parents, compliance with the mask, hemodynamic parameters and postoperative agitation of intranasal dexmedetomidine (DEX) premedication on children undergoing dental rehabilitation under general anesthesia.Methods:In the study, 60 children of American Society of Anesthesiology classification (ASA Ⅰ-Ⅱ), aged 2-9 years, were randomly assigned to one of two equal groups. Thirty minutes before operation, control group received intranasal placebo (0.9% saline) 0.02 mL/kg, and DEX group received intranasal DEX 2 μg/kg. The preoperative sedation score, the status of separation from parents, comp-liance with the mask and hemodynamic parameters were recorded by an anesthesiologists until anesthesia induction. Recovery conditions, postoperative agitation were also recorded.Results:There was no signi-ficant difference between the two groups in patient characteristics, operation time, extubation time and recovery time. Compared with the children in control group, those in DEX group were significantly more sedated when they were separated from their parents (56.7% vs. 26.7%, P<0.05). Satisfactory compliance with mask application was 40% in control group vs. 73.3% in DEX group (P<0.05). There was no significant difference between the two groups regarding the incidences of postoperative agitation and oxygen saturation (SpO₂). Compared with control group, the heart rate (HR) of DEX group was decreased after 20 minutes of drug administration [(97.13±12.93) beats/min vs.(104.53±11.97) beats/min, P<0.05]. The changes of the HR and SpO₂in the two groups were within the normal range. There were no incidences of bradycardia and hypoxemia in either of the groups during study observation.Conclusion:Premedication with intranasal DEX 2 μg/kg for children undergoing dental rehabilitation under general anesthesia produces good preoperative sedation. The levels of sedation, scores of parental separation and compliance with the mask were satisfied. The children have good recovery conditions, and no obvious postoperative agitation and respiratory depression after DEX administration. Intranasal DEX 2 μg/kg is an effective and safe alternative for premedication in children.

Key words: Dexmedetomidine, Administration, intranasal, Conscious sedation, Preoperative care, Child

中图分类号:

R782.05

高玲,刘云,杨旭东. 鼻喷右美托咪定在儿童口腔门诊全身麻醉前的镇静效果[J]. 北京大学学报（医学版）, 2018, 50(6): 1078-1082.

Ling GAO,Yun LIU,Xu-dong YANG. Effects of intranasal dexmedetomidine for children undergoing dental rehabilitation under general anesthesia: a double-blinded randomized controlled trial[J]. Journal of Peking University(Health Sciences), 2018, 50(6): 1078-1082.

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参考文献 19

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Score	Observation
1	Anxious, agitated, or restless
2	Cooperative, oriented, and tranquil
3	Responsive to commands
4	Asleep, but with brisk response to light glabellar tap or loud auditory stimulus
5	Asleep, sluggish response to glabellar tap or auditory stimulus
6	Asleep, no response

Score	Separation	Compliance with the mask	Postoperative agitation
1	Combative, clinging	Combative and angry	Calm
2	Anxious, consolable	Fear of the mask and not easily calmed	Not calm but could easily be consoled
3	Calm	Fear of the mask but easily calmed	Not easily calmed, moderately agitated, or restless
4	Sleeping	Calm and cooperative	Combative, excited, or disoriented, thrashing around

Items	Control group	DEX group	P
Age/months	43.60±12.92	46.20±10.07	0.403
Weight/kg	17.21±3.64	16.51±2.41	0.398
Male/Female	17/13	19/11	0.598
Operation time/min	177.50±33.91	181.33±39.10	0.661
Extubation time/min	5.07±1.68	5.93±2.03	0.114
Recovery time/min	25.77±12.63	29.50±12.40	0.432

	Control group	DEX group	P
Ramsay sedation score
Effective	0	18 (60.0)	<0.001
Uneffective	30 (100.0)	12 (40.0)
Separation from parent
Satisfactory	8 (26.7)	17 (56.7)	0.018
Unsatisfactory	22 (73.3)	13 (43.3)
Compliance with mask
Satisfactory	12 (40.0)	22 (73.3)	0.009
Unsatisfactory	18 (60.0)	8 (26.7)
Postoperative agitation
Satisfactory	28 (93.3)	27 (90.0)	0.640
Unsatisfactory	2 (6.7)	3 (10.0)