右美托咪定喷鼻在小儿无痛电子结肠镜检查术中的应用效果

Clinical effect of intranasal dexmedetomidine as premedication on sedation and analgesia during painless electronic colonoscopy in children

摘要:

目的 评价右美托咪定喷鼻在小儿无痛电子结肠镜检查术中的应用效果，并探索其适宜剂量。方法 择期行无痛电子结肠镜检查术的90例患儿，采用随机数字表法分成3组，每组30例，分别于检查前30 min使用咪达唑仑0.2 mg／kg（A组）、右美托咪定1.0 μg／kg（B组）和右美托咪定2.0 μg／kg（C组）喷鼻，均采用单纯丙泊酚麻醉方式，待患儿睫毛反射消失后即行结肠镜检查术。记录3组患儿喷鼻前10 min （T₀）、喷鼻后30 min （T₁）、睫毛反射消失时（T₂）、检查开始即刻（T₃）、镜身过脾曲时（T₄）、镜身过肝曲时（T₅）、术毕（T₆）及完全清醒时（T₇）的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）及脉搏血氧饱和度（SpO₂）；喷鼻前10 min以及喷鼻后10、20和30 min时的脑电双频指数（BIS）及警觉与镇静评分（OAA／S评分）；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；围术期不良反应的发生情况。以上观察项目先行3组间比较，发现差异（P＜0.05）后再行两两比较，以明确具体是哪两组间存在统计学差异（P＜0.017）。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10～30 min的BIS及OAA／S评分均明显降低（P＜0.017）。 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明显高于A组和B组（P＜0.017）。C组患儿麻醉苏醒时间和丙泊酚用量均明显短于或少于A组和B组（P＜0.017）。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明显低于A组和B组（P＜0.017）。B组和C组患儿喷鼻刺激发生率均明显低于A组（P＜0.017），C组患儿注射痛发生率均明显低于A组和B组（P＜0.017）。结论 右美托咪定喷鼻可安全用于小儿无痛电子结肠镜检查术，可有效提高患儿的依从性，具有较好的麻醉效果，且剂量2.0 μg／kg的使用效果优于1.0 μg／kg。

Abstract:

Objective To explore the clinical effect of intranasal dexmedetomidine as premedication on sedation and analgesia during painless electronic colonoscopy in children， and to investigate its optimal dose. Methods Ninety children scheduled for painless electronic colonoscopy were divided into three groups by using a computer-generated randomization schedule， 30 per group. Children were pretreated with 0.2 mg／kg midazolam （group A）， 1.0 μg／kg dexmedetomidine （group B） or 2.0 μg／kg dexmedetomidine （group C） by nasal drip 30 min before operation. The anesthesia protocol was programmed by propofol in the three groups. After eyelash reflex disappeared， the examination was performed. Mean artery blood pressure （MAP）， heart rate （HR）， respiratory rate （RR） and oxygen saturation （S_PO₂） of children were recorded at 10 min before intranasal administration （T₀）， 30 min after intranasal administration （T₁）， at the onset of eyelash reflex disappearance （T₂） and the onset of examination initiating（T₃）， at lens passing through splenic flexure （T₄）， or through hepatic flexure （T₅）， at the end of examination （T₆） and when patients were fully awake （T₇）， respectively. Bispectral index （BIS） and the observer′s assessment of alertness／sedation scale （OAA／S） were performed at 10 min before intranasal administration （T₀）， 10 min， 20 min and 30 min after intranasal administration in the three groups. Mood score at parent-children separation and venipuncture acceptance score were also recorded. The adverse reactions during examination were analyzed. The above observed indices were compared among the three groups. If there was statistical difference（P＜0.05）， pairwise comparison was performed （P＜0.017）. Results The children′s haemodynamics were all stable in the three groups. Compared with group A and group B at the same time point， BIS and OAA／S were all lower （P＜0.017） in 10 to 30 min after intranasal administration in group C. Compared with group A and group B， mood score at parent-children separation and venipuncture acceptance score were both higher （P＜0.017） in group C. Compared with group A and B， anesthetic revival time and consumption of propofol were shorter or lower in group C （P＜0.017）. Compared with group A and group B， the incidences of intraoperative adverse reactions including hypertension， sinus tachycardia， restless moving and postoperative restlessness were all lower in group C（P＜0.017）. The rate of intranasal stimulus in group B and group C were both lower than that of group A（P＜0.017）. The rate of injection pain of group C was lower （P＜0.017） than that of group A and B. Conclusion Intranasal administration of dexmedetomidine can be safely applied to children receiving painless electronic colonoscopy， and it can improve children′s compliance effectively and yield to satisfactory anesthetic effect. Moreover， the administering efficacy of dexmedetomidine with the dose of 2.0 μg／kg was superior to 1.0 μg／kg.