右美托咪定喷鼻在小儿深静脉穿刺置管术中的临床效果
投稿时间:2015-12-27  修订日期:2016-01-04  点此下载全文
引用本文:陈亮,吴学敏.右美托咪定喷鼻在小儿深静脉穿刺置管术中的临床效果[J].医学研究杂志,2016,45(7):100-104
DOI: 10.11969/j.issn.1673-548X.2016.07.027
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作者单位E-mail
陈亮 450000 郑州, 河南省胸科医院麻醉科  
吴学敏 450000 郑州人民医院麻醉科 wuxuemin1963@126.com 
中文摘要:目的 评价右美托咪定(Dex)喷鼻在小儿深静脉穿刺置管术中的临床效果。方法 择期行深静脉穿刺置管术的患儿共90例,年龄2~6岁,采用数字表法随机分成3组,每组30例:A组患儿于穿刺前30min将咪达唑仑0.2mg/kg进行喷鼻;B组和C组患儿分别于穿刺前30min将Dex 1.0μg/kg或2.0μg/kg进行喷鼻。待患儿睫毛反射消失后即行深静脉穿刺置管术。记录3组患儿喷鼻前10min(T0)、喷鼻后30min(T1)、睫毛反射消失时(T2)、穿刺开始即刻(T3)、穿刺开始后5min(T4)、穿刺结束时(T5)、穿刺结束后10min(T6)及30min(T7)时的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)及脉搏血氧饱和度(SpO2)。记录3组患儿喷鼻前10min、喷鼻后10、20和30min时的脑电双频指数(BIS)及警觉与镇静评分(OAA/S评分)。记录3组患儿与家长分离时镇静情绪评分和静脉穿刺接受程度评分。记录3组患儿穿刺前后的不良反应发生情况。结果 3组患儿术中血流动力学均较平稳。与A组和B组同时点比较,C组患儿喷鼻后10~30min的BIS及OAA/S评分均降低(P<0.05)。与A组和B组比较,C组患儿与家长分离时的镇静情绪评分及静脉穿刺接受程度评分均升高(P<0.05)。与A组和B组比较,C组患儿睫毛反射消失时间缩短(P<0.05),而麻醉苏醒时间无延长(P >0.05)。与A组和B组比较,C组患儿术中高血压、窦性心动过速、体动反应等发生率及术后躁动不安发生率均降低(P<0.05)。B组和C组患儿喷鼻刺激发生率均低于A组(P<0.05)。结论 Dex(2.0μg/kg)喷鼻用于小儿深静脉穿刺置管术,可有效地提高患儿的依从性,具有较好的镇静和镇痛效果,且不良反应发生率更低,可安全应于临床。
中文关键词:右美托咪定|咪达唑仑|喷鼻|深静脉穿刺置管|小儿
 
Clinical Efficacy of Intranasal Dexmedetomidine as Premedication on Sedation and Analgesia During Cannulation of Vena Profunda in Children
Abstract:Objective To explore the clinical efficacy of intranasal dexmedetomidine as premedication on sedation and analgesia during cannulation of vena profunda in children. Methods Using a computer-generated randomization schedule, ninety children aged from 2 to 6 years, scheduled to cannulation of vena profunda, were enrolled and diveded into three groups, 30 cases per group. Children were pretreated midazolam with 0.2mg/kg by nasal drip at 30min before operation in group A. Children received intranasally dexmedetomidine with either 1.0 or 2.0μg/kg at 30min before operation in group B or group C, respectively. After eyelash reflex of chiledren disappeared, the operation was performed. Mean artery blood pressure (MAP), heart rate (HR), respiratory rate (RR) and oxygen saturation (SPO2) of children were recorded at 10min before intranasal administration (T0), at 30min after intranasal administration (T1), at the onset of eyelash reflex disappeared (T2), at the onset of operation initiating (T3), at 5min after operation initiating (T4), at the end of operation (T5), at 10min (T6) and 30min (T7) after operation, respectively. Bispectral index (BIS) and the observer's assessment of alertness/sedation scale (OAA/S) were performed at 10min before intranasal administration (T0), 10min, 20min and 30min after intranasal administration in the three groups. Calm mood score when children and parents separated and venipuncture acceptance score were recorded in the three groups. The adverse reactions during operation were analyzed in the three groups. Results The children's haemodynamics were all fairly stable in the three groups. Compared to group A and group B at the same time point, BIS and OAA/S were all lower (P<0.05) from 10 to 30min after intranasal administration in group C. Compared to group A and group B, calm mood score when children and parents separated and venipuncture acceptance score were both higher (P<0.05) in group C. Compared to group A and group B, duration of eyelash reflex disappeared was lower (P<0.05), but anesthetic revival time was not longer (P >0.05) in group C. The rate of intranasal stimulus in group B and group C were both lower (P<0.05) than that of group A. Compared to group A and group B, the incidences of intraoperative adverse reactions including hypertension, sinus tachycardia, restless moving and postoperative restlessness were all lower (P<0.05) in group C. Conclusion Intranasal administration of Dex with a dose of 2.0μg/kg can improve children's compliance effectively, provide satisfactory sedation and analgesia for children receiving cannulation of vena profunda, decrease adverse reactions. Therefore, it can be applied to clinical practice.
keywords:Dexmedetomidine|Midazolam|Intranasal|Cannulation of vena profunda|Children
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