Du Zhen,Xiang Zhen,Wei Siwei,et al.Clinical study of dexmedetomidine in enhancing perioperative comfort during daytime pediatric surgery[J].Journal of Clinical Pediatric Surgery,2020,19(07):622-626.[doi:10.3969/j.issn.1671-6353.2020.07.012]
右美托咪定提高儿童日间手术舒适度的临床研究
- Title:
- Clinical study of dexmedetomidine in enhancing perioperative comfort during daytime pediatric surgery
- Keywords:
- Anesthesia and Analgesia; Dexmedetomidine; Comfort; Day Surgery; Child
- 分类号:
- R614.1;R726.1
- 摘要:
- 目的 对比观察右美托咪定和咪达唑仑术前用药对小儿日间手术围术期舒适度的影响。方法 选择湖南省儿童医院行择期腹股沟斜疝修补术的90名6~11岁儿童为研究对象，ASA Ⅰ~Ⅱ级。随机分为2组：咪达唑仑组（M组，n=45）和右美托咪定组（D组，n=45）。术前20 min，M组泵注咪达唑仑0.08 mg/kg；D组泵注右美托咪定0.5 μg/kg，观察两组患儿术前焦虑、术中血流动力学变化、应激反应、术后躁动和疼痛水平。结果 两组术前焦虑评分的差异无统计学意义（P>0.05）。术中和术后D组的血压（blood pressure，BP）和心率（heart rate，HR）明显低于M组（P<0.01）。D组血清肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、白介素6（interleukin-6，IL-6）、皮质醇和丙二醛的浓度低于M组（P<0.05）。两组恢复室停留时间的差异无统计学意义（P>0.05）。D组的术后疼痛评分在术后2 h和1 d显著低于M组（P<0.01），术后1周两组间差异无统计学意义（P>0.05）。D组术后2 h、1 d和1周的舒适度评分均高于M组（P<0.05）。结论 和咪达唑仑相比，右美托咪定能更好地减轻术中的应激反应、术后躁动和术后疼痛的程度，提高围手术期舒适度，是儿童日间手术镇静药物的较好选择。
- Abstract:
- Objective To compare the efficacies of dexmedetomidine versus midazolam on perioperative comfort during daytime pediatric surgery.Methods Ninety 6-11-year-old children scheduled for elective hernia repair and classified as American Society of Anesthesiologists (ASA)Ⅰ-Ⅱ were randomly divided into midazolam group (M,n=45) and dexmedetomidine group (D,n=45).In group M,midazolam was pumped at a preoperative rate of 0.08 mg/kg and dexmedetomidine at 0.5 ug/kg in group D.Preoperative anxiety,intraoperative hemodynamic changes,stress reactions,postoperative agitations and pain scores were compared between two groups.Results No significant inter-group statistical difference existed in score of separation anxiety.Blood pressure (BP) and heart rate (HR) were significantly lower in group D than those in group M (P<0.01) and the concentrations of tumor necrosis factor (TNF),interleukin-6 (IL-6),cortisol and malondialdehyde (MDA) were also significantly lower in group D than those in group M (P<0.05).No inter-group statistical difference existed in duration of recovery room.Pain scores were significantly lower in group D than those in group M at 2 hours and 1 day postoperatively (P<0.01).However,no significant difference existed at 1 week postoperatively (P>0.05).The comfort scores of group D were higher than those of group M at 2 hours,1 day and 1 week postoperatively (P<0.05).Conclusion As compared with midazolam,dexmedetomidine can better alleviate stress reactions,postoperative agitations and postoperative pain and boost postoperative satisfaction during pediatric daytime surgery.
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备注/Memo
收稿日期:2019-10-28。
基金项目:湖南省卫生计划生育委员会项目（编号：B2016042）
通讯作者:屈双权,Email:qushuangquan1974@163.com