文章摘要
术前不同剂量右美托咪定经口腔黏膜喷雾在患儿扁桃体腺样体切除术中的镇静效果
Sedative effect of administration of different doses of buccal dexmedetomidine in pediatric patients undergoing tonsillectomy and/or adenoidectomy
  
DOI:
中文关键词: 右美托咪定  患儿  口腔黏膜  镇静  镇痛
英文关键词: Dexmedetomidine  Pediatric patient  Buccal administration  Sedation  Analgesia
基金项目:福建省自然科学基金(2016J01588)
作者单位
蔡志明 350025,福州总医院麻醉科 
吴黄辉 350025,福州总医院麻醉科 
张燕 350025,福州总医院麻醉科 
柯慧华 350025,福州总医院麻醉科 
陈国忠 350025,福州总医院麻醉科 
吴晓智 350025,福州总医院麻醉科 
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中文摘要:
      目的 观察术前经口腔黏膜喷雾给予不同剂量右美托咪定在患儿扁桃体腺样体手术围麻醉期的镇静效果。方法 选择2014年6月至2016年5月于本院耳鼻喉科行择期扁桃体和/或腺样体切除术的患儿80例,男54例,女26例,年龄4~12岁,ASA Ⅰ或Ⅱ级。随机分为四组,每组20例,分别于入室前60 min经口腔黏膜喷雾给予右美托咪定0 μg/kg(A组)、1 μg/kg(B组)、2 μg/kg(C组)和4 μg/kg(D组)。记录患儿给药前及给药后10、20、30、40、50和60 min的镇静深度(OAA/S)评分;记录手术结束后首次自主呼吸出现时间、睁眼时间、气管导管拔除时间、拔管前镇静-躁动程度(SAS)及拔管后60 min内的OAA/S评分、疼痛情况(FLACC)和术后60 min内呼吸抑制、恶心呕吐、过度镇静等不良反应的发生情况。结果 与A、B组比较,C、D组给药后60 min内OAA/S评分明显升高(P<0.05),拔管前SAS评分明显降低(P<0.05)。D组拔管后5 min的OAA/S评分明显低于A、B组(P<0.05)。D组拔管后30和60 min的FLACC评分明显低于A组(P<0.05)。D组术后首次自主呼吸出现时间、睁眼时间和气管导管拔除时间明显长于A、B、C组(P<0.05)。四组不良反应差异无统计学意义。结论 患儿入室前60 min经口腔黏膜喷雾给予右美托咪定2或4 μg/kg,可安全有效地提供患儿入室时满意的镇静深度,减轻患儿麻醉恢复期因气管导管留置和疼痛应激引起的躁动。
英文摘要:
      Objective To investigate the sedative effect of different doses of buccal dexmedetomidine premedication during peri-anesthesia in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Methods Eighty pediatric patients undergoing tonsillectomy and/or adenoidectomy in department of otorhinolaryngology, 54 males and 26 females, aged 4-12 years, ASA Ⅰ or Ⅱ, from June, 2014 through May, 2016 were enrolled, n=20 in each group. Children were randomly assigned to receive buccal dexmedetomidine 0 μg/kg (group A), 1 μg/kg (group B), 2 μg/kg (group C) and 4 μg/kg (group D) 60 min before transporting to operating room. Sedation score (OAA/S scale) was monitored before and after administering buccal dexmedetomidine. Time of post-operative first spontaneous respiration, opening eyes, extubation, anxiety score (SAS scale), as well as OAA/S scale, pain intensity (FLACC), and adverse events 60 min after surgery were recorded. Results Compared with group A and group B, markedly superior OAA/S within 60 min after administering buccal dexmedetomidine in group C and group D were observed (P<0.05). Compared with group A and group B, the OAA/S score 5 min after extubation was lower in group D. FLACC scores within 30 and 60 min after extubation in group D were lower than those in group A. Group D showed obviously prolonged time of post-operative first spontaneous respiration, opening eyes and extubation compared with the other groups (P<0.05). All the rates of adverse events were similar. Conclusion 2 or 4 μg/kg premedecation of buccal dexmedetomidine 60 min before transporting to operating room can effectively and safely sedate pediatric patients when entered operating room, improve parental separation, mask and sevoflurane acceptance, as well as decrease the stress induced by intubation and post-operative pain.
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