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目的观察术前经鼻应用右美托咪定对扁桃体及腺样体切除术患儿围术期镇静和血流动力学的影响。方法 60例拟行扁桃体及腺样体切除手术患儿随机分为3组,每组20例,麻醉诱导前30min分别经鼻滴入右美托咪定1μg/kg(1μg/kg组)、2μg/kg(2μg/kg组)和等容量生理盐水(对照组)。观察3组术前镇静满意率和面罩接受度,记录麻醉诱导、气管插管及拔管前、后患儿血流动力学变化情况,记录术后拔管时间、PACU停留时间、苏醒期躁动及术后恶心、呕吐发生情况。结果 1μg/kg组和2μg/kg组患儿用药后30min镇静满意率(80%、95%)、面罩接受满意率(50%、85%)、离别情绪评分[(3.3±0.5)、(3.8±0.7)分]高于对照组[10%、20%、(2.1±1.1)分](P<0.05),气管插管及拔管前、后患儿心率、血压波动低于对照组(P<0.05),1μg/kg组和2μg/kg组苏醒期躁动发生率(15%、10%)和术后恶心、呕吐发生率(5%、0)均低于对照组(40%、25%)(P<0.05);1μg/kg组术后拔管时间[(11.6±5.3)min]、PACU停留时间[(39.9±4.2)min]与对照组[(9.8±2.4)min、(37.6±3.1)min]比较差异均无统计学意义(P>0.05),2μg/kg组术后拔管时间[(18.6±4.2)min]较对照组长,20min镇静满意率(90%)、面罩接受满意率(85%)高于1μg/kg组(55%、50%)(P<0.05)。结论小儿扁桃体及腺样体切除术前经鼻滴入右美托咪定安全、可行,2μg/kg右美托咪定可提高围术期镇静效果。
Objective To observe the effect of preoperative nasal dexmedetomidine on perioperative sedation and hemodynamics in children with tonsil and adenoidctomy. Methods Sixty children with tonsillectomy and adenoidectomy were randomly divided into 3 groups (n = 20 in each group). The animals were treated with dexmedetomidine 1μg / kg (1μg / kg) and 2μg / kg (2μg / kg group) and equal volume of saline (control group). The satisfaction rate of preoperative sedation and mask acceptance were observed in 3 groups. The changes of hemodynamics in anesthesia induction, tracheal intubation and extubation were recorded. The duration of extubation, PACU stay time, recovery period agitation and Postoperative nausea, vomiting. Results The satisfaction rate (50%, 85%), the sentiment score [(3.3 ± 0.5), (3.8), the sedation satisfaction rate at 30 min after treatment in the 1 μg / kg and 2 μg / ± 0.7) points higher than those in the control group (10%, 20%, 2.1 ± 1.1) (P <0.05). The heart rate and blood pressure fluctuation of children before and after tracheal intubation and extubation were lower than that of the control group 0.05). The incidence of agitation (15%, 10%) and postoperative nausea and vomiting (5%, 0) in 1μg / kg group and 2μg / kg group were lower than those in control group (40% ) (P <0.05). The time of extubation in 1μg / kg group was (11.6 ± 5.3) min and the PACU stay time was (39.9 ± 4.2) min in control group (18.6 ± 4.2) min in the 2μg / kg group was longer than that in the control group, and the satisfaction rate (90%) in the 20min group was significantly lower than that in the control group The satisfaction rate (85%) was higher than that of 1μg / kg group (55%, 50%) (P <0.05). Conclusions Pediatric tonsillectomy and adenoidectomy nasal drip dexmedetomidine safe and feasible, 2μg / kg dexmedetomidine can improve perioperative sedation.