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| 右美托咪定对全麻患儿术后行为改变的影响 |
| Effect of low-dose dexmedetomidine on postoperative behavioral changes in children with general anesthesia |
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| DOI：10.12089/jca.2019.08.014 |
| 中文关键词: 右美托咪定 患儿 苏醒期躁动 术后行为改变 |
| 英文关键词: Dexmedetomidine Preschool children Emergence agitation Postoperative behavioral changes |
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| 中文摘要: |
目的 观察术中输注右美托咪定对全麻患儿术后行为改变的影响。
方法 择期在全麻下行扁桃体切除术患儿90例，男67例，女23例，年龄2~7岁，体重10~40 kg，ASA Ⅰ或Ⅱ级。采用随机数字表法将其分为两组，每组45例。D组患儿在麻醉诱导后静脉泵注右美托咪定0.5 μg/kg，C组患儿在相同时点给予等量的生理盐水，两组泵注时间均为10 min。记录PACU期间躁动发生例数、躁动评分和疼痛发生率、疼痛评分；记录拔管及苏醒时间、拔管后PACU停留时间、术后不良事件发生情况及镇痛药物补救例数。采用术后行为量表，分别在术后1、7、30 d 对患儿父母进行术后问卷调查及电话随访，获得患儿术后不良行为改变情况。
结果 与C组比较，D组苏醒期躁动发生率、躁动评分、疼痛发生率、疼痛评分均明显降低（P<0.05），拔管及苏醒时间明显延长（P<0.01）。两组患儿镇痛药补救率、拔管后PACU停留时间、术后恶心呕吐等不良事件发生率差异无统计学意义。与术后1 d比较，术后30 d两组术后不良行为改变发生率均明显下降（P<0.01）。与C组比较，术后1、7 d D组术后不良行为改变发生率明显降低（P<0.05）。术后30 d两组术后不良行为改变发生率差异无统计学意义。
结论 术中输注右美托咪定0.5 μg/kg不仅可有效预防苏醒期躁动，还能降低全麻患儿术后行为改变的发生率，以改善分离焦虑尤为明显。 |
| 英文摘要: |
Objective To evaluate the effect of intraoperative dexmedetomidine on postoperative behavioral changes in children with general anesthesia.
Methods Ninety children scheduled for elective tonsilectomy, 67 males and 23 females, aged 2-7 years, weighing 10-40 kg, ASA physical status Ⅰ or Ⅱ, were equally divided into 2 groups using a random number table, 45 cases in each group. After induction of anesthesia, children were respectively received 0.5 μg/kg of dexmedetomidine (group D) or volume-matched normal saline (group C). The infusion time of both groups was 10 min. The incidence and severity of emergence agitation, the occurrence of pain, the time of extubation and emergence, PACU length of stay after extubation, adverse events, and the percentage of patients requiring rescue analgesic were recorded. The post hospitalization behavior questionnaire (PHBQ) was used to observe negative postoperative behavioural changes (NPOBCs) 1, 7 and 30 days after discharge via parent phone surveys.
Results Compared with group C, the incidence of agitation and pain, agitation scores and pain scores in group D were significantly lower (P < 0.05), but extubation time and emergence time were significantly longer (P < 0.01). There was no significant difference in the percentage of patients requiring rescue analgesic, PACU length of stay after extubation, and the incidence of adverse events. Compared with 1 day after surgery, the incidence of NPOBCs 30 days postoperatively in the two groups was significantly decreased (P < 0.01). Compared with group C, the incidence of NPOBCs in group D was significantly lower 1 and 7 days after surgery (P < 0.05), but there was no significant difference on 30th day after operation.
Conclusion Intraoperative dexmedetomidine 0.5 μg/kg can reduce the incidence of postoperative behavioral changes in children with general anesthesia. |
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