右美托咪定术前滴鼻对腹腔镜手术患儿苏醒期躁动和外周血炎性介质水平的影响
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摘要
目的观察右美托咪定(DEX)术前滴鼻对腹腔镜手术患儿苏醒期躁动和外周血炎症介质水平的影响。方法按随机数表法将2016年7月至2017年12月择期行腹腔镜手术患儿60例分为DEX术前滴鼻组(研究组,n=30)和0.9%氯化钠溶液组(对照组,n=30)。记录手术时间、苏醒时间、麻醉恢复室(PACU)停留时间,记录2组患儿滴鼻前(T1)、滴鼻5 min后(T2)、拔管即刻(T3)、拔管5 min后(T4)、送出PACU时(T5)时血流动力学参数[心率(HR)、平均动脉压(MAP)]、呼吸参数[呼吸频率(RR)、血氧饱和度(SpO_2)、呼气末二氧化碳(ETCO_2)],于T1、T5时检测2组患儿血清炎症介质[白介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)],比较2组患儿T4时疼痛[东大略儿童医院疼痛评分(CHEOPS)]、躁动[躁动评分(PAED)]情况差异,观察不良反应发生情况。结果 2组手术时间、苏醒时间、PACU停留时间、不良反应发生率差异均无统计学意义(P>0.05)。T1～T5时,2组患儿HR、MAP则于T2、T3时逐步升高,于T4、T5时逐步降低,研究组波动幅度小于对照组,2组上述指标组间效应、时间点效应及组间·时间点交互效应均有显著统计学意义(P<0.05)。T1～T5时,2组RR、SpO_2、ETCO_2组间效应、时间点效应及组间·时间点交互效应均无统计学意义(P>0.05)。T5时,2组血清IL-6、TNF-α、CRP水平均较T1时上升,且研究组低于对照组(P<0.05)。研究组T4时CHEOPS、PAED评分低于对照组(P<0.05)。结论 DEX术前滴鼻有助于维持腹腔镜手术患儿血流动力学稳定,并可显著减轻其炎症反应和苏醒期躁动情况,对患儿恢复时间、呼吸无明显影响,安全性良好。
Objective To observe the effects of preoperative nasal drip with dexmedetomidine(DEX) on the agitation and peripheral blood inflammatory mediators levels in children patients during laparoscopic surgery.Methods A total of 60 children patients who underwent laparoscopic surgery in our hospital from July 2016 to December 2017 were enrolled in the study,who were divided into DEX preoperative nasal drip group(research group, n=30) and saline group(control group,n=30) according to the random number table method. The operative time, awakening time and the stay time in postanesthesia care unit(PACU) were recorded. Moreover the hemodynamic parameters including heart rate(HR), mean arterial pressure(MAP) and respiratory parameters including respiratory rate(RR), oxygen saturation(SpO_2) and end-tidal carbon dioxide(ETCO_2) were recorded in both groups before nasal drops(T1), at 5 min after nasal drops(T2), extubation immediately(T3), at 5 min after extubation(T4) and discharging from PACU(T5). In addition the serum inflammatory mediators levels including interleukin-6(IL-6), C-reactive protein(CRP), tumor necrosis factor-α(TNF-α) at T1 and T5 were detected in both groups, and pain scores of Children's Hospital of Eastern Ontario Pain Scale(CHEOPS) and agitation scores of Pediatric Anesthesia Emergence Delirium(PAED) as well as the incidence of adverse reactions were observed and compared between the two groups.Results There were no significant differences in operative time, recovery time, PACU stay time and incidence rate of adverse reactions between the two groups(P>0.05). The levels of HR and MAP at T2 and T3 were gradually increased in both groups,however,which at T2 and T3 were gradually decreased, and the fluctuation extent in research group was smaller than that in control group, and there were statistically significant differences in above indexes betweenthe two groups(P<0.05).At T1～T5, there were no significant differences in effects betweenthe two groups, time-points effects and interaction effects of between-groups and time-points of RR, SpO_2 and ETCO_2 between the two groups(P>0.05). At T5, the serum levels of IL-6, TNF-α, and CRP were increased in bth groups,as compared with those at T1,moreover,which in research group were significantly lower than those in control group(P<0.05).In addition the scores of CHEOPS and PAED at T4 in research group were significantly lower than those in control group(P<0.05). Conclusion DEX for preoperative nasal drip helps to maintain hemodynamic stability in children patients undergoing laparoscopic surgery, which can significantly reduce the inflammatory response and agitation,moreover,which has no significant effects on the recovery time and breathing of patients, with good safety.
Objective To observe the effects of preoperative nasal drip with dexmedetomidine(DEX) on the agitation and peripheral blood inflammatory mediators levels in children patients during laparoscopic surgery.Methods A total of 60 children patients who underwent laparoscopic surgery in our hospital from July 2016 to December 2017 were enrolled in the study,who were divided into DEX preoperative nasal drip group(research group, n=30) and saline group(control group,n=30) according to the random number table method. The operative time, awakening time and the stay time in postanesthesia care unit(PACU) were recorded. Moreover the hemodynamic parameters including heart rate(HR), mean arterial pressure(MAP) and respiratory parameters including respiratory rate(RR), oxygen saturation(SpO_2) and end-tidal carbon dioxide(ETCO_2) were recorded in both groups before nasal drops(T1), at 5 min after nasal drops(T2), extubation immediately(T3), at 5 min after extubation(T4) and discharging from PACU(T5). In addition the serum inflammatory mediators levels including interleukin-6(IL-6), C-reactive protein(CRP), tumor necrosis factor-α(TNF-α) at T1 and T5 were detected in both groups, and pain scores of Children's Hospital of Eastern Ontario Pain Scale(CHEOPS) and agitation scores of Pediatric Anesthesia Emergence Delirium(PAED) as well as the incidence of adverse reactions were observed and compared between the two groups.Results There were no significant differences in operative time, recovery time, PACU stay time and incidence rate of adverse reactions between the two groups(P>0.05). The levels of HR and MAP at T2 and T3 were gradually increased in both groups,however,which at T2 and T3 were gradually decreased, and the fluctuation extent in research group was smaller than that in control group, and there were statistically significant differences in above indexes betweenthe two groups(P<0.05).At T1～T5, there were no significant differences in effects betweenthe two groups, time-points effects and interaction effects of between-groups and time-points of RR, SpO_2 and ETCO_2 between the two groups(P>0.05). At T5, the serum levels of IL-6, TNF-α, and CRP were increased in bth groups,as compared with those at T1,moreover,which in research group were significantly lower than those in control group(P<0.05).In addition the scores of CHEOPS and PAED at T4 in research group were significantly lower than those in control group(P<0.05). Conclusion DEX for preoperative nasal drip helps to maintain hemodynamic stability in children patients undergoing laparoscopic surgery, which can significantly reduce the inflammatory response and agitation,moreover,which has no significant effects on the recovery time and breathing of patients, with good safety.
引文
1 王刚,吴荣德.腔镜在小儿外科中的应用.中华实用儿科临床杂志,2017,32:816-818.
2 周晓筠,吴靦,朱毅,等.不同麻醉方法对小儿腹腔镜手术应激反应和复苏质量的影响.实用医学杂志,2017,33:2186-2188.
3 蔡军,于刚,缪江波,等.七氟醚吸入麻醉、丙泊酚静脉麻醉在小儿腹腔镜手术中的应用效果比较.山东医药,2015,55:74-75,88.
4 Kim HJ,Kim DK,Sohn TS,et al.A laparoscopic gastrectomy approach decreases the incidence and severity of emergence agitation after sevoflurane anesthesia.J Anesth,2015,29:223-228.
5 蒋文军,杨孟昌,徐冰.七氟醚复合舒芬太尼与氯胺酮麻醉对疝气腹腔镜手术患儿的临床效果及血液流变学分析.中国医院药学杂志,2016,36:838-840.
6 张艳华,刘立成,董蕤,等.右美托咪定预防小儿腹腔镜手术苏醒期躁动的影响研究.现代中西医结合杂志,2016,25:1574-1575.
7 Chen XH,Wang ZJ,Xiang QM,et al.Effect of dexmedetomidine alone for postoperative analgesia after laparoscopic cholecystectomy.Zhonghua Yi Xue Za Zhi,2017,97:295-299.
8 贾英萍,李郑琛,邱永升.右美托咪定滴鼻复合七氟醚吸入麻醉在小儿舌系带成形术中的应用.新乡医学院学报,2015,6:732-734.
9 Gu H,Liu J,Wu C.Impact of dexmedetomidine versus propofol on cardiac function of children undergoing laparoscopic surgery.Int J Clin Exp Med,2014,7:5882-5885.
10 刘莹,刘天婧,王恩波.不同年龄段儿童疼痛评估工具的选择.中国疼痛医学杂志,2012,18:752-755.
11 纪怀珠,欧阳碧山,宁巧明.地佐辛预防小儿全身麻醉苏醒期躁动的临床研究.中国现代医学杂志,2017,27:108-112.
12 郝玉苓.静吸复合麻醉与全凭静脉麻醉在小儿腹腔镜手术中的应用对比分析.中国现代医学杂志,2016,26:84-86.
13 钟剑洪,刘妙雯,梁江惠.喉罩与气管插管全麻对小儿腹腔镜手术气道恢复质量影响的比较.广东医学,2016,37:2424-2425.
14 上官世金,段鹏静.两种低流量麻醉药物用于小儿腹腔镜手术的回顾性分析.中国药房,2015,26:3709-3711.
15 任娟娟,王义,唐春春,等.合并轻度上呼吸道感染患儿腹腔镜手术全身麻醉的安全性及预后评估.山东医药,2015,55:15-16,19.
16 廉伟,孙静林,刘彦涛.不同气腹压对小儿腹腔镜手术P(ET)CO2、MAP及心率的影响.陕西医学杂志,2017,46:1185-1187.
17 史宇平,田园,杨海昌,等.丙泊酚与七氟醚麻醉对小儿腹腔镜疝囊高位结扎术血流动力学及并发症的影响.检验医学与临床,2017,14:1709-1711.
18 蒋文军,张敏,张远,等.七氟烷联合舒芬太尼注射液在小儿腹股沟斜疝腹腔镜手术中的麻醉效果.中国临床药理学杂志,2017,33:1534-1536.
19 孙静林,刘彦涛,刘印华,等.血气分析对小儿腹腔镜术后苏醒期的指导意义.河北医科大学学报,2015,36:1343-1345.
20 王宇,刘菊英,李清,等.右美托咪定对小儿腹腔镜手术麻醉恢复期躁动的影响.重庆医学,2014,43:4794-4795.
21 Liang FG,Ouyang MW,et al.Effects of dexmedetomidine on propofol dosage in target-controlled infusion and hemodynamics during laparoscopic surgery under general anesthesia.Nan Fang Yi Ke Da Xue Xue Bao,2015,35:1497-1500.
22 顾洪斌,朱明,吴赤.右美托咪定联合七氟烷对腹腔镜手术中儿童心功能的影响.医学临床研究,2013,30:1272-1274.
23 Yao Y,Qian B,Chen Y,et al.Intranasal dexmedetomidine premedication reduces the minimum alveolar concentration of sevoflurane for tracheal intubation in children:a randomized trial.J Clin Anesth,2014,26:309-314.
24 徐卫团,喻文立.右美托咪定的临床应用进展.医学综述,2017,23:1830-1834.
25 Plambech MZ,Afshari A.Dexmedetomidine in the pediatric population:a review.Minerva Anestesiol,2015,81:320-332.
26 李安学,纪宏新,陈文,等.等剂量右美托咪定滴鼻或含服用于患儿面罩吸入麻醉诱导前镇静效果的比较.中国新药与临床杂志,2018,37:99-102.
27 刘剑霞,杜敏,刘巍,等.右美托咪定联合氯胺酮滴鼻用于小儿术前镇静的效果评估.重庆医科大学学报,2017,42:1671-1675.
28 岳冬梅,刘苏,张月英,等.右美托咪定术前滴鼻在小儿腹股沟疝手术中的应用.重庆医学,2016,45:1034-1036.
2 周晓筠,吴靦,朱毅,等.不同麻醉方法对小儿腹腔镜手术应激反应和复苏质量的影响.实用医学杂志,2017,33:2186-2188.
3 蔡军,于刚,缪江波,等.七氟醚吸入麻醉、丙泊酚静脉麻醉在小儿腹腔镜手术中的应用效果比较.山东医药,2015,55:74-75,88.
4 Kim HJ,Kim DK,Sohn TS,et al.A laparoscopic gastrectomy approach decreases the incidence and severity of emergence agitation after sevoflurane anesthesia.J Anesth,2015,29:223-228.
5 蒋文军,杨孟昌,徐冰.七氟醚复合舒芬太尼与氯胺酮麻醉对疝气腹腔镜手术患儿的临床效果及血液流变学分析.中国医院药学杂志,2016,36:838-840.
6 张艳华,刘立成,董蕤,等.右美托咪定预防小儿腹腔镜手术苏醒期躁动的影响研究.现代中西医结合杂志,2016,25:1574-1575.
7 Chen XH,Wang ZJ,Xiang QM,et al.Effect of dexmedetomidine alone for postoperative analgesia after laparoscopic cholecystectomy.Zhonghua Yi Xue Za Zhi,2017,97:295-299.
8 贾英萍,李郑琛,邱永升.右美托咪定滴鼻复合七氟醚吸入麻醉在小儿舌系带成形术中的应用.新乡医学院学报,2015,6:732-734.
9 Gu H,Liu J,Wu C.Impact of dexmedetomidine versus propofol on cardiac function of children undergoing laparoscopic surgery.Int J Clin Exp Med,2014,7:5882-5885.
10 刘莹,刘天婧,王恩波.不同年龄段儿童疼痛评估工具的选择.中国疼痛医学杂志,2012,18:752-755.
11 纪怀珠,欧阳碧山,宁巧明.地佐辛预防小儿全身麻醉苏醒期躁动的临床研究.中国现代医学杂志,2017,27:108-112.
12 郝玉苓.静吸复合麻醉与全凭静脉麻醉在小儿腹腔镜手术中的应用对比分析.中国现代医学杂志,2016,26:84-86.
13 钟剑洪,刘妙雯,梁江惠.喉罩与气管插管全麻对小儿腹腔镜手术气道恢复质量影响的比较.广东医学,2016,37:2424-2425.
14 上官世金,段鹏静.两种低流量麻醉药物用于小儿腹腔镜手术的回顾性分析.中国药房,2015,26:3709-3711.
15 任娟娟,王义,唐春春,等.合并轻度上呼吸道感染患儿腹腔镜手术全身麻醉的安全性及预后评估.山东医药,2015,55:15-16,19.
16 廉伟,孙静林,刘彦涛.不同气腹压对小儿腹腔镜手术P(ET)CO2、MAP及心率的影响.陕西医学杂志,2017,46:1185-1187.
17 史宇平,田园,杨海昌,等.丙泊酚与七氟醚麻醉对小儿腹腔镜疝囊高位结扎术血流动力学及并发症的影响.检验医学与临床,2017,14:1709-1711.
18 蒋文军,张敏,张远,等.七氟烷联合舒芬太尼注射液在小儿腹股沟斜疝腹腔镜手术中的麻醉效果.中国临床药理学杂志,2017,33:1534-1536.
19 孙静林,刘彦涛,刘印华,等.血气分析对小儿腹腔镜术后苏醒期的指导意义.河北医科大学学报,2015,36:1343-1345.
20 王宇,刘菊英,李清,等.右美托咪定对小儿腹腔镜手术麻醉恢复期躁动的影响.重庆医学,2014,43:4794-4795.
21 Liang FG,Ouyang MW,et al.Effects of dexmedetomidine on propofol dosage in target-controlled infusion and hemodynamics during laparoscopic surgery under general anesthesia.Nan Fang Yi Ke Da Xue Xue Bao,2015,35:1497-1500.
22 顾洪斌,朱明,吴赤.右美托咪定联合七氟烷对腹腔镜手术中儿童心功能的影响.医学临床研究,2013,30:1272-1274.
23 Yao Y,Qian B,Chen Y,et al.Intranasal dexmedetomidine premedication reduces the minimum alveolar concentration of sevoflurane for tracheal intubation in children:a randomized trial.J Clin Anesth,2014,26:309-314.
24 徐卫团,喻文立.右美托咪定的临床应用进展.医学综述,2017,23:1830-1834.
25 Plambech MZ,Afshari A.Dexmedetomidine in the pediatric population:a review.Minerva Anestesiol,2015,81:320-332.
26 李安学,纪宏新,陈文,等.等剂量右美托咪定滴鼻或含服用于患儿面罩吸入麻醉诱导前镇静效果的比较.中国新药与临床杂志,2018,37:99-102.
27 刘剑霞,杜敏,刘巍,等.右美托咪定联合氯胺酮滴鼻用于小儿术前镇静的效果评估.重庆医科大学学报,2017,42:1671-1675.
28 岳冬梅,刘苏,张月英,等.右美托咪定术前滴鼻在小儿腹股沟疝手术中的应用.重庆医学,2016,45:1034-1036.