Zhang Shuibing,Kang Xin,Chen Zheng,et al.Effect of dexmedetomidine nasal spray on emergence agitation in children undergoing eye surgery[J].Journal of Clinical Pediatric Surgery,2025,(10):969-974.[doi:10.3760/cma.j.cn101785-202503114-012]
右美托咪定鼻喷雾剂对眼科手术患儿全身麻醉苏醒期躁动的影响
- Title:
- Effect of dexmedetomidine nasal spray on emergence agitation in children undergoing eye surgery
- Keywords:
- Dexmedetomidine; Nasal Sprays; Ophthalmic Surgery; Anesthesia; General; Emergence Delirium
- 摘要:
- 目的 观察右美托咪定鼻喷雾剂对眼科手术患儿全身麻醉苏醒期躁动的影响。方法 本研究为随机对照研究,采用随机数字表法,将符合纳入标准的行择期眼科手术的患儿随机分为右美托咪定鼻喷雾剂组(dexmedetomidine nasal spray,DS)和生理盐水喷鼻组(saline nasal spray,NS)。两组患儿均在麻醉诱导前20 min接受喷鼻给药。主要观察两组患儿在麻醉复苏室(postanesthesia care unit,PACU)10 min(T1)、20 min(T2)、30 min(T3)三个时间点的麻醉苏醒期躁动发生率。次要观察指标为两组麻醉诱导时(T0)、T1、T2、T3四个时间点的心率、平均动脉压;PACU期间苏醒期躁动的严重程度、发生躁动时的补救措施(环泊酚用量)、苏醒时间、PACU停留时间、Ramsay镇静评分、FLACC疼痛评分,以及两组不良反应情况、家长满意度。结果 右美托咪定鼻喷雾剂组患儿麻醉苏醒期躁动发生率显著低于生理盐水喷鼻组(14.62%比35.73%),差异有统计学意义(P=0.027)。右美托咪定鼻喷雾剂组患儿PACU期间环泊酚补救用量[0(0,0)mg比0(0,5)mg]及术中瑞芬太尼用量[297(283,322)μg比325(289,364)μg]显著低于对照组,差异有统计学意义(P＜0.05),患儿家属满意度也高于对照组(78.01%比54.82%),差异有统计学意义(P=0.044)。右美托咪定鼻喷雾剂组较生理盐水喷鼻组麻醉诱导时(T0)的心率[(101.31±7.39)次/分比(109.72±7.87)次/分],差异有统计学意义(P<0.01),平均动脉压明显低于生理盐水喷鼻组[(61.21±5.79)mmHg比(64.62±4.88)mmHg],差异有统计学意义(P<0.01)。两组患儿在PACU期间的心率、平均动脉压、Ramsay镇静评分、疼痛评分、术后不良反应发生情况比较,差异均无统计学意义(P>0.05)。结论 右美托咪定鼻喷雾剂可有效降低眼科手术患儿全身麻醉苏醒期躁动的发生率,且不影响其苏醒进程,值得临床推广应用,但应注意监测患儿心率和血压。
- Abstract:
- Objective To observe the effect of dexmedetomidine nasal spray on emergence agitation in children undergoing eye surgery. Methods Children fulfilling the inclusion criteria for elective eye surgery were randomized into two groups of dexmedetomidine nasal spray (DS) and saline nasal spray (NS).Both groups received intranasal dosing at 20 min before anesthesia induction.The incidence of emergence agitation in postanesthesia care unit(PACU)was recorded at 10 min (T1),20 min (T2) and 30 min (T3).Heart rate and mean arterial pressure at four timepoints of anesthesia induction (T0),T1,T2 and T3;severity of emergence agitation,remedies for agitation (cyclopofol dosage),recovery time,residence time in PACU,Ramsay sedation score,FLACC pain score and the occurrence of adverse events during PACU staying were recorded along with parental satisfaction of medical experience. Results The incidence of emergence agitation was significantly lower in DS group than that in NS group (14.62% vs.35.73%,P=0.027).The dosage of cyclopofol during PACU and remifentanil usage during operation in DS group were significantly lower than those in control group.And the statistical results were [0(0,0) vs.0(0,5) mg,P=0.035]and [297(283,322) vs.325(289,364) μg,P=0.014](P<0.05) respectively.Parental satisfaction was higher in DS group than that in control group (78.01% vs.54.82%,P=0.044)(P<0.05).However,heart rate and mean arterial pressure in DS group at the time of anesthesia induction (T0) were significantly lower than those in NS group [(101.31±7.39) vs.(109.72±7.87) times per min,P<0.01]and [(61.21±5.79) vs.(64.62±4.88) mmHg,P<0.01],respectively.No significant inter-group differences existed in heart rate,mean arterial pressure,Ramsay sedation score,FLACC pain score or postoperative adverse events during PACU (P>0.05). Conclusions Dexmedetomidine nasal spray can effectively lower the incidence of emergence agitation in children undergoing eye surgery.Without any effect on recovery,it is worthy of wider clinical promotions and applications.However,monitoring of heart rate and blood pressure in children should be strengthened.
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备注/Memo
收稿日期:2025-3-31。
通讯作者:杜真,Email:meggyzhen@163.com