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摘要：
探讨右美托咪定（dexmedetomidine, DEX）滴鼻用于小儿腺样体、扁桃体切除手术的有效性及安全性。 方法 选择择期行腺样体、扁桃体切除的患儿160例，年龄3~7岁，ASAⅠ~Ⅱ级，患儿采用随机数字表法，随机分为四组：DEX 1ug/kg组（D1.0组），DEX 1.5ug/kg组（D1.5组），DEX 2ug/kg组（D2.0组），对照组滴入生理盐水（S组），每组40例。由麻醉准备间麻醉护士配置好滴鼻液，总量均为1ml，患儿在家属陪同下由一名麻醉医生用滴鼻器经鼻滴入容量为1ml的滴鼻液，记录患儿滴鼻给药后10min、20min、30min的平均动脉压（mean arterial pressure, MAP），心率（heart rate, HR），指脉氧饱和度（surplus pulse O2, SpO2）。30min后将患儿接入手术室，进行静脉穿刺，记录患儿的Funk评分。麻醉诱导采用丙泊酚 2mg/kg，芬太尼 3ug/kg，维库溴铵0.1mg/kg，经口气管插管，术中以七氟醚及瑞芬太尼维持麻醉，维持Narcotrend指数(narcotrend index, NI)在40~60之间。手术结束时停止药物泵注，记录苏醒时间，拔管时间，并对患儿术后进行小儿麻醉苏醒期躁动（pediatric anaesthesia emergence delirium, PAED）评分及改良加拿大东安大略儿童医院疼痛评分（modified the Children's Hospital of Eastern Ontario Pain Scale, m-CHEOPS）。 结果 D1.0组患儿静脉穿刺抵抗评分较 D1.5组及D2.0组低，差异有统计学意义（P＜0.05）。瑞芬太尼用量S组大于DEX滴鼻组，差异有统计学意义（P＜0.05）。S组患儿拔管即刻(T5)，拔管后5min(T6)的MAP、HR与其它三组比较，差异有统计学意义（P＜0.05）。患儿苏醒后入恢复室，S组患儿PAED评分，m-CHEOPS评分高于其它三组，差异有统计学意义（P＜0.05）。D2.0组有两例患儿术后出现嗜睡，其它各组患儿无并发症发生。 结论 DEX术前30min滴鼻，能有效并安全的用于小儿腺样体及扁桃体切除，1ug/kg 及 1.5ug/kg 滴鼻安全性优于2ug/kg滴鼻。
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Abstract: To discuss the efficiency and security of intranasal dexmedetomidine(DEX) with different dosage in pediatric undergoing tonsillectomy and adenoidectomy. Methods 160 patients aged 3 to 7, undergoing selective tonsillectomy and adenoidectomy, ASAⅠ~Ⅱ, randomly divided into four groups: DEX 1ug/kg (D1.0), DEX 1.5ug/kg (D1.5), DEX 2.0ug/kg (D2.0), and control group(S). 30 min pre-operation, patients received intranasal naristillae, the volume is 1ml, records the mean arterial pressure (MAP), heart rate(HR), and SPO2 every 10min after intranasal naristillae. Then given intravenous puncture, records Funk score. Anesthesia inducted with propofol 2mg/kg, fentanyl 3ug/kg, vecuromium 0.1mg/kg, and endotracheal intubated. Anesthesia is maintained with sevoflurane and remifentanyl continous refusion until the operation finished. Records recovery time, extubation time, and evaluated PAED score and m-CHEOPS score in recovery room. Results The intravenous puncture resistance scores are significantly lower in D1.0 than those group(P＜0.05). There are no significant differences in operation time, recovery time and extubation time among the four groups(P＞0.05). The consumptions of remifentanyl are higher in control group compared with DEX grups(P＜0.05), MAP and HR at T5 and T6 are also higher in control group(P＜0.05). PAED scores and m-CHEOPS scores are higher in control group than DEX groups(P＜0.05). There are two patients had drowsiness symptom in D2.0 group. Conclusion Intranasal DEX 30min pre-operation, have efficiency and security in pediatric undergoing tonsillectomy and adenoidectomy. The dosage of intranasal DEX with 1ug/kg and 1.5ug/kg are more safer than 2ug/kg.
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