国际麻醉学与复苏杂志   2019, Issue (6): 0-0
    
右美托咪定经口腔黏膜喷雾与滴鼻在小儿术前镇静效果中的比较
王金璇, 蒋宝峰, 张心怡, 李金宝1()
1.潍坊医学院麻醉学系
Comparison of preoperative sedation effect of dexmedetomidine via oral mucosa spray and nasal drip in children
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摘要:

目的 比较右美托咪定(dexmedetomidine, Dex)经口腔黏膜喷雾与滴鼻两种不同给药方式在小儿术前镇静中的效果。 方法 择期行腹股沟区小型手术的小儿60例,年龄1~5岁,ASA分级Ⅰ级。按随机数字表法分为:滴鼻组(N组)和经口腔黏膜喷雾组(B组),每组30例。术前40 min经鼻或经口腔黏膜给予小儿Dex 1.5 μg/kg。记录给药前及给药后10、20、30、40 min时的心率、SpO2、警觉/镇静量表(Observer Assessment of Alertness and Anxiety Scale, OAA/S)评分,观察两组小儿药物接受情况、入手术室时与父母分离情况、诱导时面罩接受程度等指标,记录小儿在PACU期间不良事件的发生。 结果 B组小儿药物接受满意度高于N组(P<0.05);N组和B组镇静起效时间分别为20、30 min(P<0.05),给药后40 min OAA/S评分差异无统计学意义(P>0.05);N组、B组小儿心率分别于用药20、30 min后较用药前明显下降(P<0.05);两组小儿与父母分离、面罩接受满意度差异无统计学意义(P>0.05);两组小儿在PACU期间均无术后不良反应发生。 结论 小儿术前经口腔黏膜或滴鼻途径给予Dex 均可取得良好的镇静效果,滴鼻方式药物起效快,但经口腔黏膜给药小儿更易接受。

关键词: 右美托咪定; 小儿; 经口腔黏膜喷雾; 滴鼻; 镇静
Abstract:

Objective To evaluate the effects of dexmedetomidine (Dex) by oral mucosa spray versus nasal drip in preoperative sedation in children. Methods Sixty children underwent minor elective surgery in the inguinal region, aged 1 to 5 y, and American Society of Anesthesiologists (ASA) grade Ⅰ. They were divided into two groups according to the random number table method: the nasal drip group (group N) and the oral mucosa spray group (group B), 30 cases in each group. The children were given Dex 1.5 μg/kg by nasal drip or oral mucosa 40 min before surgery. Heart rate, pluse oxygen saturation(SpO2) and observer assessment of alertness and anxiety scale (OAA/S) were measured before and 10, 20, 30, 40 min after administration. The drug acceptance, parental separation anxiety scale and mask acceptance scale of the two groups were observed, and the occurrence of adverse events during the post-anesthesia care unit(PACU) was recorded. Results Drug acceptance satisfaction in group B was higher than in group N (P<0.05). The medicine sedation onset time was 20 min and 30 min in group N and group B (P<0.05), there was no significant difference in OAA/S sedation scores 40 min after administration (P>0.05). Heart rate of group N and group B decreased significantly at 20, 30 min after medication respectively (P<0.05). There was no significant difference between the two groups in parental separation anxiety scores and mask acceptance scores (P>0.05). No postoperative adverse reactions occurs in children during in the PACU. Conclusions A good sedative effect can be obtained by administration of Dex via oral mucosa spray or nasal drip route. The nasal drip mode works quickly, but it is more easily accepted by children during oral mucosa administration.

Key words: Dexmedetomidine; Child; Oral mucosa spray; Nasal drip; Sedation