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目的:观察右美托咪定术前滴鼻对行扁桃体腺样体切除术患儿在围术期血流动力学和苏醒期躁动的影响。方法:择期行扁桃体腺样体切除术的患儿60例,随机分为右美托咪定组(D组)和生理盐水组(C组)。在麻醉诱导前30 min,D组患儿经鼻滴入右美托咪定,C组患儿经鼻滴入生理盐水。给药30 min后,进行静脉麻醉诱导。记录患儿的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_2),患儿滴鼻接受程度、手术时间、拔管时间以及并发症的发生情况;根据麻醉苏醒期躁动量化评分表(PEAD)和改良加拿大东安大略儿童医院疼痛评分量表(m-CHEOPS)对患儿进行评分并记录术后苏醒期躁动发生率。结果:与C组相比,D组各个时间点的MAP、HR有统计学差异(P<0.05),D组围术期生命体征变化相对平稳;两组患儿SpO_2、滴鼻接受程度、患儿手术时间比较均无统计学意义(P>0.05);两组患儿拔管时间比较有差异(P<0.05);D组患儿苏醒期PAED评分和m—CHEOPS评分均低于C组患儿(P<0.05);两组患儿在围术期均无恶心呕吐,喉痉挛等不良反应的发生。结论:右美托咪定滴鼻可安全、有效的用于小儿患者,并且可使围术期血流动力学平稳及减少苏醒期躁动的发生。
Objective: To observe the effects of dexmedetomidine preoperative intranasal nasal drops on perioperative hemodynamics and wakefulness in children undergoing tonsillectomy. Methods: Sixty children with tonsillectomy undergoing elective adenoidectomy were randomly divided into dexmedetomidine group (D group) and saline group (C group). At 30 minutes before induction of anesthesia, children in group D were dripped into dexmedetomidine by nasal route, and children in group C were given nasal instillation of saline. After administration for 30 min, intravenous anesthesia was induced. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO_2), nasal acceptability, operation time, extubation time and complication in children were recorded. Score (PEAD) and modified Children’s Hospital East Ontario Pain Rating Scale (m-CHEOPS) were scored and the incidence of post-operative recovery from agitation was recorded. Results: Compared with group C, the MAP and HR of group D were significantly different at all time points (P <0.05), and the change of perioperative vital signs in group D was relatively stable. The SpO2, nasal acceptability, (P> 0.05). There was significant difference between the two groups in the extubation time (P <0.05). The PAED score and m-CHEOPS score of awake group in both groups were significantly lower than those in group C Children (P <0.05). There was no nausea and vomiting and laryngospasm in the two groups during perioperative period. Conclusion: Dexmedetomidine nasal drops can be safely and effectively used in pediatric patients, and can stabilize perioperative hemodynamics and reduce the restlessness agitation.