右美托咪定滴鼻对患儿扁桃体腺样体切除术后恢复的影响

Effect of dexmedetomidine intranasal instillation on postoperative recovery after tonsillectomy and adenoidectomy in children

中文关键词: 右美托咪定  滴鼻  扁桃体腺样体切除  术后恢复

英文关键词: Dexmedetomidine  Intranasal instillation  Tonsillectomy and adenoidectomy  Postoperative recovery

中文摘要:

      
目的 通过儿童自我报告术后恢复问卷（self-reported postoperative recovery in children，PRiC）分析术前经鼻滴入右美托咪定1 μg/kg对患儿扁桃体腺样体切除术后恢复的影响。
方法 纳入行扁桃体腺样体切除手术的患儿100例，男65例，女35例，年龄4~12岁，ASA Ⅰ或Ⅱ级，随机分为两组：右美托咪定组（D组）和生理盐水组（N组），每组50例，分别于术前30 min经鼻滴入右美托咪定1 μg/kg或等体积生理盐水。于术后1、3、7 d晨采用PRiC对患儿术后恢复情况进行评估。评估内容包括扁桃体术后恢复相关的23个条目，包括日常生活活动（睡觉、进食、玩耍），身体症状（头痛、耳痛、胃痛、咽喉痛、恶心、大小便情况）和情绪方面（情绪低落、噩梦）的评估，得分越高，表示在相关项目中的状态越差。同时于术前、术后1、3 d晨检测患儿血常规。
结果 术后1、3、7 d D组经常及频繁出现咽喉疼痛的患儿明显少于N组（P<0.05）。术后1 d D组经常及频繁出现情绪低落，睡眠、进食、玩耍、交谈、刷牙、此刻的感觉表现为不好及非常不好的患儿明显少于N组（P<0.05）。术后1 d D组白细胞计数明显低于N组（P<0.05）。
结论 对于行扁桃体腺样体切除术的患儿，通过儿童自我报告术后恢复问卷获取的数据结果显示，术前30 min右美托咪定1 μg/kg滴鼻对术后恢复有促进作用。

英文摘要:

      
Ojective To analyze the effect of dexmedetomidine intranasal instillation on postoperative recovery after tonsillectomy and adenoidectomy in children by the use of self-reported postoperative recovery in children(PPiC).
Methods One hundred patients who underwent the tonsillectomy and adenoidectomy, 65 males and 35 females, aged 4 - 12 years, falling into ASA physical status Ⅰ or Ⅱ, were randomly assigned to dexmedetomidine group (n = 50) and saline group (n = 50). Patients received intranasal instillation with 1 μg/kg of dexmedetomidine or same volume of saline 30 minutes before surgery. The PPiC was used to assess postoperative recovery after tonsillectomy and adenoidectomy in children on postoperative day 1, 3 and 7. The white blood cell count before and after surgery were measured.
Results The postoperative recovery of the dexmedetomidine group was significantly better than that of the saline group (P < 0.05). The white blood cell count in the dexmedetomidine group were markedly lower than those in the saline group 1 day after surgery ( P < 0.05) and returned to the baseline level on postoperative day 3.
Conclusion PRiC seems to be able to serve as a patient-reported outcome measures to obtain patient-centered data after tonsillectomy and adenoidectomy. Intranasal instillation with 1 μg/kg of dexmedetomidine 30 minutes before tonsillectomy and adenoidectomy can promote postoperative recovery.