Effects of Dexmedetomidine on the Incidence of Emergence Delirium after General Anesthesia in Pediatric Patients Undergoing Hip Surgery
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摘要:
目的 评价术中连续输注右美托咪啶对髋关节手术患儿全麻苏醒期谵妄（PAED）的影响。 方法 择期髋部手术患儿70例，年龄3～6岁，ASAⅠ～Ⅱ，随机分为两组，每组35例。麻醉诱导气管插管后右美托咪啶组[D组 右美托咪啶0.3 μg/（kg·h）输入]；对照组[C组 相同容积的生理盐水输入]分别持续静脉输入至手术结束前30 min。所有患儿手术结束拔出气管导管后送入PACU，主要观察患儿拔出气管导管后30 min内PAED发生率、疼痛发生率，评估拔出气管导管后10、20、30、60 min、24 h疼痛评分、PAED评分，其次，记录拔管时间，应急镇痛药使用率和出PACU时护士满意度评分。 结果 与C组相比，D组患儿苏醒期谵妄（PaedED）发生率和疼痛发生率降低[（48.6% vs 22.9%，P < 0.01）；（62.9% vs 37.1%），P < 0.05）]，D组拔管后不同时点的疼痛评分和PAED评分降低（P < 0.05），但拔管时间延长（P < 0.05）。在PACU期间D组应急镇痛药使用率减少，护士满意度增高，差异有统计学意义（P < 0.05）。术后24 h疼痛评分、PAED评分两组，差异无统计学意义（P > 0.05）。 结论 术中连续输注右美托咪啶0.3 μg/（kg·h）可降低髋关节手术患儿全麻苏醒期谵妄的发生率。 Abstract:Objective To evaluate the effect of continuous infusions of dexmedetomidine on the pediatric anesthesia emergence delirium （PAED）after general anesthesia in pediatric patients undergoing hip surgery. Methods Seventy children, ASA class I-II, aged 3～6 years scheduled for elective hip surgery under general anesthesia. The patients were randomly assigned to two groups. The dexmedetomidine group （group D, n = 35）, which received dexmedetomidine infusion at a rate of 0.3 μg/（kg·h） after induction of anesthesia until to 30 minutes before the end of surgery and the control group （group C, n = 35）, which received a volume-matched normal saline infusion as a placebo at the same time. All children were sent to the PACU after extubation. The primary outcome was the incidence of paedED and pain within 30 minutes after extubation. The scale of pain and paedED were recorded at 10, 20, 30, 60 minutes and 24h after extubation. In addition, the extubation time, the incidence of requiring rescue analgesic and the satisfaction scale of nurse were recorded as well. Results Compared with the Group C, the incidence of pain and the paediatric emergence delirium （PaedED）were significantly decreased respectively in group D （48.6% vs 22.9%; P < 0.01; 62.9% vs 37.1% P < 0.05）, but extubation time was prolonged （ P < 0.05）. The satisfaction scale of nurse was significantly higher and the incidence of requiring rescue analgesic was significantly lower in Group D than it was in Group C during PACU （ P < 0.05, respectively）. There was no statistically significant difference between the pain score and the PAED score at 24 hours after surgery. Conclusion Continuous infusions of dexmedetomidine 0.3 μg/（kg·h）can reduce the incidence of paedED after general anesthesia in pediatric patients undergoing hip surgery. -
Key words:
- Dexmedetomidine /
- PAED /
- Hip surgery /
- Children
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表 1 儿童苏醒期谵妄评分量表（分）
Table 1. The pediatric anesthesia emergence deliriumscale（score）
项目 没有 有一点 有一些 有许多 完全有 与看护者发生眼神交流 4 3 2 1 0 行为有目的性 4 3 2 1 0 对周围环境认知 4 3 2 1 0 不安 0 1 2 3 4 难以安抚 0 1 2 3 4 注：总评分为20分，≥12分为中度paedED，≥15分为重度paedED。 
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表 2 2组患儿一般资料比较（
$\bar x\pm s $ ）Table 2. Comparison of general data between two groups（
$\bar x\pm s $ ）组别 n 年 龄（岁） 体重（kg） 男/女（n） C组 35 3.5 ± 1.4 16.4 ± 5.9 12/23 D组 35 3.7 ± 1.2 17.8 ± 5.2 10/25
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表 3 2组患儿术中资料比较（
$\bar x\pm s $ ）Table 3. Comparison of the data of during operation between two groups（
$\bar x\pm s $ ）组别 手术时间（min） 出血量（mL） 输血量（mL） 总入量（mL） 丙泊酚用量（mg） C组 169 ± 42 251 ± 48 287 ± 63 688 ± 90 177 ± 43 D组 174 ± 39 260 ± 56 279 ± 79 694 ± 102 185 ± 58
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表 4 2患儿术后疼痛评分比较（
$\bar x\pm s $ ）Table 4. Comparison of the scale of FLACC after operation between two groups（
$ \bar x\pm s$ ）组别 10 min 20 min 30 min 60 min 24 h C组 4.54 ± 0.83 4.96 ± 0.97 4.88 ± 0.67 4.84 ± 0.7 5.28 ± 1.21 D组 2.38 ± 0.69 △ 2.46 ± 0.56△ 3.09 ± 0.74△ 3.02 ± 0.59△ 5.19 ± 1.34 与C组比较，△P < 0.05。
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表 5 2组患儿术后PAED评分比较（
$\bar x \pm s $ ）Table 5. Comparison of the scale of PAED after operation between two groups （
$\bar x \pm s $ ）组别 10 min 20 min 30 min 60 min 24 h C组 11.04 ± 2.73 10.76 ± 3.72 10.83 ± 3.77 6.84 ± 3.65 4.12 ± 1.09 D组 5.18 ± 1.42△△ 6.01 ± 2.45△ 6.18 ± 2.53△ 6.18 ± 2.48 4.08 ± 1.14 与C组比较，△P < 0.05，△△P < 0.01。
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表 6 2组患儿术后其它指标比较（
$\bar x \pm s $ ）Table 6. Comparison of the other data of after operation between two groups （
$\bar x \pm s $ ）组别 C组 D组 P 拔管时间（min） 17.7 ± 4.7 25.4 ± 5.2 < 0.05 PaedED≥12发生率（%） 17（48.6） 9（22.9） < 0.01 曲马多使用率（%） 19（54.2） 10（28.6） < 0.05 疼痛发生率（%） 22（62.9） 13（37.1） < 0.05 护士满意度 3.73 ± 0.97 2.59 ± 0.89 < 0.05 病房布洛芬悬滴液服用率（%） 91.5（32） 97.1（34） > 0.05
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