CAJ | 학술논문

目的：经鼻滴入右旋美托咪啶可使患儿达到镇静状态。文中旨在比较经鼻滴入不同剂量的右旋美托咪啶在不同年龄患儿的镇静效果。方法择期行单侧腹股沟疝气手术的患儿90例，年龄1～8岁，其中1～4岁52例，5～8岁38例， ASAⅠ-Ⅱ级，分为3组：右旋美托咪啶1μg/kg组、右旋美托咪啶2μg/kg组和对照组，每组30例。所有患儿术前35 min监测心率、平均动脉压（mean artery pressure， MAP）。右旋美托咪啶1μg/kg组经鼻滴入右旋美托咪啶1μg/kg；右旋美托咪啶2μg/kg滴入右旋美托咪啶2μg/kg；对照组滴入等渗盐水0．4 mL；30 min后采用七氟烷吸入诱导，建立静脉通路，静注舒芬太尼0．2μg/kg，放入喉罩，术中七氟烷维持麻醉，术毕恢复室观察2 h。记录用药前、用药后10 min、用药后20 min、用药后30 min、术毕时、清醒时的心率、MAP、RR、SpO2，应用Ramsay评分评估镇静满意度，记录镇静起效时间、术毕苏醒时间。结果在1～4岁年龄段，右旋美托咪啶1μg/kg组、右旋美托咪啶2μg/kg组的镇静满意率、镇静起效时间及苏醒时间差异无统计学意义（ P＞0．05）；右旋美托咪啶1μg/kg组、右旋美托咪啶2μg/kg组的镇静满意率（52％、53％）明显高于对照组（9％），差异有统计学意义（ P＜0．05）。在5～8岁年龄段，右旋美托咪啶2μg/kg组的镇静满意率（77％）明显高于右旋美托咪啶1μg/kg组（45％）和对照组（22％），右旋美托咪啶1μg/kg组的镇静满意率（45％）明显高于对照组（22％），差异有统计学意义（P＜0．05）。3组患儿围术期的MAP、心率和SpO2差异均无统计学意义（P＞0．05）。结论1～4岁的患儿术前经鼻滴入1μg/kg或2μg/kg的右旋美托咪啶产生镇静的效果接近，5～8岁的患儿经鼻滴入2μg/kg的该药可达到更高的镇静满意率。
목적：경비적입우선미탁미정가사환인체도진정상태。문중지재비교경비적입불동제량적우선미탁미정재불동년령환인적진정효과。방법택기행단측복고구산기수술적환인90례，년령1～8세，기중1～4세52례，5～8세38례， ASAⅠ-Ⅱ급，분위3조：우선미탁미정1μg/kg조、우선미탁미정2μg/kg조화대조조，매조30례。소유환인술전35 min감측심솔、평균동맥압（mean artery pressure， MAP）。우선미탁미정1μg/kg조경비적입우선미탁미정1μg/kg；우선미탁미정2μg/kg적입우선미탁미정2μg/kg；대조조적입등삼염수0．4 mL；30 min후채용칠불완흡입유도，건립정맥통로，정주서분태니0．2μg/kg，방입후조，술중칠불완유지마취，술필회복실관찰2 h。기록용약전、용약후10 min、용약후20 min、용약후30 min、술필시、청성시적심솔、MAP、RR、SpO2，응용Ramsay평분평고진정만의도，기록진정기효시간、술필소성시간。결과재1～4세년령단，우선미탁미정1μg/kg조、우선미탁미정2μg/kg조적진정만의솔、진정기효시간급소성시간차이무통계학의의（ P＞0．05）；우선미탁미정1μg/kg조、우선미탁미정2μg/kg조적진정만의솔（52％、53％）명현고우대조조（9％），차이유통계학의의（ P＜0．05）。재5～8세년령단，우선미탁미정2μg/kg조적진정만의솔（77％）명현고우우선미탁미정1μg/kg조（45％）화대조조（22％），우선미탁미정1μg/kg조적진정만의솔（45％）명현고우대조조（22％），차이유통계학의의（P＜0．05）。3조환인위술기적MAP、심솔화SpO2차이균무통계학의의（P＞0．05）。결론1～4세적환인술전경비적입1μg/kg혹2μg/kg적우선미탁미정산생진정적효과접근，5～8세적환인경비적입2μg/kg적해약가체도경고적진정만의솔。
Objective Intranasal drops of dexmedetomidine can induce conscious sedation in children .This study was to com-pare the sedative effects of different doses of intranasal dexmedetomidine in different age groups of children patients . Methods We e-qually randomized 90 hernia children waiting for elective unilateral inguinal surgery ( ASAⅠ-Ⅱ) to groupsⅠ,ⅡandⅢ.At 35 minutes be-fore surgery, we obtained the heart rate (HR), mean artery pressure (MAP) of all the patients.The children in groupsⅠandⅡreceived nasal instillation of dexmedetomidine at 1 and 2μg/kg respectively, while those in groupⅢ0.4 mL of normal saline, followed by sevoflu-rane induction, intravenous injection of sufentanil (0.2μg/kg), and laryngeal mask airway anesthesia with sevoflurane .We recorded HR, MAP before medication, at 10 min, 20 min and 30 min before mediation, right after surgery, and at the recovery to consciousness . We also recorded the sedation onset time and post-surgery recovery time and assessed sedation satisfaction using the Ramsay score . Results The rates of satisfactory preoperative sedation were 50 and 63% in groupsⅠandⅡ, significantly higher than 10%in groupⅢ(P<0.05). In the 1-4-year group, the sedation satisfaction rate , sedation onset <br> time and post-surgery recovery time showed no significant differences between groupsⅠandⅡ(P>0.05).In the 5-8-year group, seda-tion satisfaction rate was markedly higher in groupⅡthan in groupsⅢ(77%vs 22%, P<0.05) andⅠ(77%vs 45%) . Conclusion At 1 and 2μg/kg, intranasal drops of dexmedetomidine produces similar rates of satisfactory sedation in children aged 1-4 years, and at 2μg/kg can achieve an even higher rate of satisfactory sedation without adverse hemodynamic effects in those aged 5-8 years.