天津医药

天津医药 ›› 2022, Vol. 50 ›› Issue (6): 658-662.doi: 10.11958/20212436

• 药物临床观察 • 上一篇    下一篇

右美托咪定不同给药方式预防小儿术后不良行为改变的比较研究

王志芬，章艳君，刘金柱△   

  1. 天津市儿童医院麻醉科（邮编300074）
  • 收稿日期:2021-11-01 修回日期:2022-02-02 出版日期:2022-06-15 发布日期:2023-12-20
  • 通讯作者: 王志芬 E-mail:15602176894@163.com
  • 基金资助:
    天津医学会麻醉学分会青年科研培育基金项目（2018KYJJ-7）

A comparative study on different administration methods of dexmedetomidine in the prevention of negative postoperative adverse behavior in children

WANG Zhifen, ZHANG Yanjun, LIU Jinzhu△   

  1. Department of Anesthesiology, Tianjin Children’s Hospital, Tianjin 300074, China
  • Received:2021-11-01 Revised:2022-02-02 Published:2022-06-15 Online:2023-12-20
  • Contact: 志芬 王 E-mail:15602176894@163.com

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摘要： 摘要：目的　探讨右美托咪定术前滴鼻与术中静脉泵注对全麻患儿术后不良行为改变（NPOBCs）的影响。方法　237例拟全麻下行腹腔镜疝囊高位结扎术的患儿按随机数字表法分为3组：P组（术前30 min经鼻滴注右美托咪定2 μg/kg，诱导插管后给予生理盐水0.5 mL/kg静脉泵注10 min）、I组（术前30 min经鼻滴注生理盐水0.02 mL/kg、术中右美托咪定0.5 μg/kg静脉泵注10 min）、C组（术前30 min经鼻滴注生理盐水0.02 mL/kg，诱导插管后给予生理盐水0.5 mL/kg静脉泵注10 min）。记录3组改良耶鲁术前焦虑评分（mYPAS）、诱导期合作（ICC）评分、拔管时间、苏醒时间、麻醉恢复室（PACU）时间，FLACC评分、躁动情况，在术后第1、7、30天采用术后行为学量表（PHBQ）对患儿父母进行电话随访，观察患儿术后行为改变的情况。结果　与C组和I组比较，P组ICC评分降低（P＜0.05）；与C组和P组比较，I组拔管时间、苏醒时间、PACU时间延长（P＜0.05）；与C组比较，P组和I组FLACC评分、术后躁动和术后第1、7天NPOBCs及分离焦虑的发生率降低（P＜0.05）。结论　术前右美托咪定滴鼻和术中右美托咪定静脉泵注对于全麻患儿术后第1、7天NPOBCs均有改善，主要以减轻分离焦虑为主。2种给药方式对于NPOBCs的预防效果并无明显差异。

关键词: 右美托咪啶；输注, 静脉内；投药, 鼻内；腹腔镜手术；术后不良行为改变；儿童

Abstract: Abstract: Objective　To investigate the effects of preoperative nasal drip and intraoperative intravenous infusion of dexmedetomidine on negative postoperative behavioral changes (NPOBCs) in children under general anesthesia. Methods　A total of 237 children who underwent laparoscopic surgery were randomly divided into three groups: the group P (received intranasal dexmedetomidine 2 μg/kg at the 30 minutes before operation, and intravenous infusion of saline 0.5 mL/kg for 10 min after intubation), the group I (received intranasal 0.02 mL/kg normal saline 30 min before operation, and intravenous infusion of dexmedetomidine 0.5 μg/kg for 10 min after intubation), the group C (received intranasal 0.02 mL/kg normal saline 30 min before operation, and intravenous infusion of saline 0.5 mL/kg for 10 min after intubation). Modified Yale Pre-operative Anxiety Scale, ICC scores, extubation time, recovery time, PACU time, FLACC scores, agitation and perioperative adverse events were recorded. The parents were followed up by telephone at 1, 7 and 30 days after operation using PHBQ. The behavior changes after operation were observed in children. Results　Compared with the group C and the group I, the ICC scores decreased in the group P (P＜0.05). Compared with the group C and the group P, the extubation time, recovery time and PACU time were prolonged in the group I (P＜0.05). Compared with the group C, the FLACC scores and the incidence of agitation were significantly lower in the group P and the group I (P＜0.05). Compared with the group C, the incidence of NPOBCs decreased on the 1st and 7th day after operation in the group P and the group I (P＜0.05), and the incidence of separation anxiety decreased on the 1st and 7th day after operation in the group P and the group I (P＜0.05). Conclusion　The intranasal and intraoperative intravenous infusion dexmedetomidine in children undergoing laparoscopic surgery can improve NPOBCs on the 1st and 7th day after operation, mainly to reduce separation anxiety. There is no significant difference in the prevention intensity of NPBOCs between the two administration methods.

Key words: dexmedetomidine, infusions, intravenous, administration, intranasal, laparoscopic surgery, postoperative behavioral changes, child