腹腔镜腹股沟斜疝手术患儿麻醉诱导前应用右美托咪定的影响

doi:10.3877/cma.j.issn.1674-392X.2020.03.007

目的

探究麻醉诱导前应用右美托咪定（DEX）对腹腔镜腹股沟斜疝手术患儿应激反应、血流动力学及苏醒质量的影响。

方法

选取2017年2月至2018年12月，临高县人民医院84例腹腔镜腹股沟斜疝手术患儿为研究对象，采用随机数字表法分为DEX组及对照组，每组42例。DEX组麻醉诱导前给予DEX滴鼻，对照组麻醉诱导前则给予生理盐水滴鼻。比较2组入室时（T0）、麻醉诱导前（T1）、建立气腹时（T2）、手术结束时（T3）血流动力学[平均动脉压（MAP）、心率（HR）]和T0、T3时应激反应[去甲肾上腺素（NE）、肾上腺素（E）]与T0、T1时焦虑状态[改良耶鲁手术前焦虑量表（mYPAS）]，并记录2组麻醉诱导配合度[麻醉诱导期合作量表（ICC）]、麻醉苏醒情况（呼吸恢复时间、拔管时间、苏醒时间）、不良反应发生情况。

结果

2组T0、T1时组内及组间MAP、HR比较，差异无统计学意义（P>0.05）；2组T2、T3时MAP、HR均低于T0、T1（P<0.05），T3则低于T2（P<0.05）；且T2、T3时，DEX组MAP、HR均低于对照组（P<0.05）。T3时，2组血清NE、E均较T0时升高（P<0.05），且对照组高于DEX组（P<0.05）。对照组T0、T1时mYPAS评分比较，差异无统计学意义（P>0.05）；T1时，DEX组mYPAS评分较T0时降低（P<0.05），且低于对照组（P<0.05）。DEX组ICC评分及呼吸恢复时间、拔管时间、苏醒时间、术后躁动发生率均低于对照组（P<0.05）。2组不自主运动、恶心呕吐、分泌物增多发生情况比较，差异无统计学意义（P>0.05）。

结论

麻醉诱导前应用DEX能提高腹腔镜腹股沟斜疝手术麻醉苏醒质量，减少术后躁动，还能降低患儿术中血流动力学波动及应激反应，在减轻术前焦虑、提高患儿配合度方面也有重要作用。

关键词: 右美托咪定, 腹股沟斜疝, 腹腔镜, 应激反应, 血流动力学, 苏醒质量

Objective

To explore the effects of dexmedetomidine (DEX) on stress response, hemodynamics and recovery quality in children patients undergoing laparoscopic indirect inguinal hernia surgery before anesthesia induction.

Methods

From February 2017 to December 2018, eighty-four children underwent laparoscopic indirect hernia surgery in Lingao County People's hospital were selected for the study. They were divided into DEX group and control group according to the random number table method, with 42 cases in each group. DEX group was given DEX nasal drip before anesthesia induction, and control group was given saline nasal drip before anesthesia induction. Hemodynamics [mean arterial pressure (MAP), heart rate (HR)] at entering the room (T0), before anesthesia induction (T1), at pneumoperitoneum establishment (T2) and at the end of surgery (T3) and stress response [norepinephrine (NE), epinephrine (E)] at T0 and T3 and anxiety status [Modified Yale preoperative anxiety scale (mYPAS)] at T0 and T1 were compared between the two groups, and the anesthesia induction coordination [anesthesia induction cooperation scale (ICC)], anesthesia recovery (respiratory recovery time, extubation time, recovery time) and occurrence of adverse reactions were recorded in the two groups.

Results

There were no significant differences in the MAP and HR within the groups at T0 and T1 and between the groups (P>0.05). The MAP and HR at T2 and T3 were lower than those at T0 and T1 (P<0.05), and the indexes at T3 were lower than those at T2 (P<0.05). At T2 and T3, the MAP and HR in DEX group were lower than those in control group (P<0.05). At T3, the levels of serum NE and E in the two groups were higher than those at T0 (P<0.05), and the levels in control group were higher than those in DEX group (P<0.05). There was no significant difference in the mYPAS score between at T0 and at T1 in control group (P>0.05). At T1, the mYPAS score in DEX group was lower than that at T0 (P<0.05), and was lower than that in control group (P<0.05). The ICC score and respiratory recovery time, extubation time, recovery time and incidence rate of postoperative agitation in DEX group were lower than those in control group (P<0.05). There were no significant differences in the occurrence of involuntary movement, nausea and vomiting and increased secretion between the two groups (P>0.05).

Conclusion

DEX before anesthesia induction for laparoscopic indirect inguinal hernia surgery can improve the anesthesia recovery quality and reduce the postoperative agitation. It can also reduce the intraoperative hemodynamic fluctuation and stress response, and it also plays an important role in reducing preoperative anxiety and improving the coordination degree of children patients.

Key words: Dexmedetomidine, Indirect inguinal hernia, Laparoscopy, Stress response, Hemodynamics, Recovery quality

表1 2组腹股沟斜疝手术患儿围手术期MAP、HR比较（±s）

时间	DEX组(42例)		对照组(42例)
时间	MAP(mmHg)	HR(次/min)	MAP(mmHg)	HR(次/min)
T0	73.22±6.39	104.32±9.25	72.19±5.75	103.15±10.21
T1	71.55±6.19	101.57±9.11	71.96±6.23	102.32±9.62
T2	67.56±5.49^ab*	88.71±7.86^ab*	70.05±5.32^ab	94.25±8.24^ab
T3	61.84±5.24^abc*	83.45±7.22^abc*	67.23±6.34^abc	90.51±7.96^abc

表1 2组腹股沟斜疝手术患儿围手术期MAP、HR比较（±s）

时间	DEX组(42例)		对照组(42例)
时间	MAP(mmHg)	HR(次/min)	MAP(mmHg)	HR(次/min)
T0	73.22±6.39	104.32±9.25	72.19±5.75	103.15±10.21
T1	71.55±6.19	101.57±9.11	71.96±6.23	102.32±9.62
T2	67.56±5.49^ab*	88.71±7.86^ab*	70.05±5.32^ab	94.25±8.24^ab
T3	61.84±5.24^abc*	83.45±7.22^abc*	67.23±6.34^abc	90.51±7.96^abc

表2 2组腹股沟斜疝手术患儿T0、T3时血清去甲肾上腺素、肾上腺素比较（ng/ml，±s）

组别	例数	去甲肾上腺素		肾上腺素
组别	例数	T0	T3	T0	T3
DEX组	42	68.79±11.54	95.46±13.87^a	79.65±10.28	108.46±15.84^a
对照组	42	65.94±10.39	113.51±18.42^a	76.48±12.19	125.18±19.33^a
t值	?	1.189	5.073	1.288	4.336
P值	?	0.238	<0.001	0.201	<0.001

表2 2组腹股沟斜疝手术患儿T0、T3时血清去甲肾上腺素、肾上腺素比较（ng/ml，±s）

组别	例数	去甲肾上腺素		肾上腺素
组别	例数	T0	T3	T0	T3
DEX组	42	68.79±11.54	95.46±13.87^a	79.65±10.28	108.46±15.84^a
对照组	42	65.94±10.39	113.51±18.42^a	76.48±12.19	125.18±19.33^a
t值	?	1.189	5.073	1.288	4.336
P值	?	0.238	<0.001	0.201	<0.001

表3 2组腹股沟斜疝手术患儿mYPAS、ICC评分比较（分，±s）

组别	例数	mYPAS		ICC
组别	例数	T0	T1	ICC
DEX组	42	38.45±3.89	31.56±3.28^a	3.11±0.67
对照组	42	37.69±4.04	36.94±3.65	5.98±1.24
t值	?	0.878	7.105	13.197
P值	?	0.382	<0.001	<0.001

表3 2组腹股沟斜疝手术患儿mYPAS、ICC评分比较（分，±s）

组别	例数	mYPAS		ICC
组别	例数	T0	T1	ICC
DEX组	42	38.45±3.89	31.56±3.28^a	3.11±0.67
对照组	42	37.69±4.04	36.94±3.65	5.98±1.24
t值	?	0.878	7.105	13.197
P值	?	0.382	<0.001	<0.001

表4 2组腹股沟斜疝手术患儿麻醉苏醒情况比较（min，±s）

组别	例数	呼吸恢复时间	拔管时间	苏醒时间
DEX组	42	7.54±1.85	17.45±3.55	35.11±6.59
对照组	42	13.59±1.96	27.89±4.27	45.79±6.15
t值	?	14.548	12.184	7.679
P值	?	<0.001	<0.001	<0.001

表4 2组腹股沟斜疝手术患儿麻醉苏醒情况比较（min，±s）

组别	例数	呼吸恢复时间	拔管时间	苏醒时间
DEX组	42	7.54±1.85	17.45±3.55	35.11±6.59
对照组	42	13.59±1.96	27.89±4.27	45.79±6.15
t值	?	14.548	12.184	7.679
P值	?	<0.001	<0.001	<0.001

表5 2组腹股沟斜疝手术患儿不良反应发生情况比较[例（%）]

组别	例数	不自主运动	术后躁动	恶心呕吐	分泌物增多
DEX组	42	2(4.76)	1(2.38)	3(6.52)	2(4.76)
对照组	42	3(6.52)	8(19.05)	6(14.29)	4(9.52)
χ²值	?	-	4.480	0.498	0.180
P值	?	0.450	0.034	0.480	0.672

表5 2组腹股沟斜疝手术患儿不良反应发生情况比较[例（%）]

组别	例数	不自主运动	术后躁动	恶心呕吐	分泌物增多
DEX组	42	2(4.76)	1(2.38)	3(6.52)	2(4.76)
对照组	42	3(6.52)	8(19.05)	6(14.29)	4(9.52)
χ²值	?	-	4.480	0.498	0.180
P值	?	0.450	0.034	0.480	0.672

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Effects of dexmedetomidine before anesthesia induction in children undergoing laparoscopic indirect inguinal hernia surgery

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Effects of dexmedetomidine before anesthesia induction in children undergoing laparoscopic indirect inguinal hernia surgery