[罂粟摘要]术前药物治疗儿童的术前焦虑水平与术后消极行为改变无关

术前药物治疗儿童的术前焦虑水平与术后消极行为改变无关

贵州医科大学     麻醉与心脏电生理课题组

翻译 :  马艳燕     编辑 :  严旭     审校 :  曹莹

背景：部分研究表明，儿童麻醉诱导前焦虑会导致长期焦虑和消极行为改变（NBC），而其他研究尚未发现这种影响。这项来自最近一项比较可乐定和咪达唑仑术前用药试验的二次分析旨在测试无论用药类型如何，用改良耶鲁术前焦虑量表 （mYPAS） 评估的术前焦虑与使用院后行为问卷 （PHBQ） 评估的术后消极行为变化之间的关系。

方法：这是一项计划中的二次分析，来自一项已发表的2-7岁门诊手术队列的术前用药比较试验。评估受试者和术前因素，特别是用mYPAS量表评估的术前焦虑与术后消极行为改变发展的关系。

结果：115名受试者中有54名存在高度的麻醉诱导前焦虑（mYPAS>30），19名在术后1周出现3次以上术后消极行为改变。诱导前焦虑水平（mYPAS评分）与术后1周（10/19例，p=0.62）和术后4周或26周消极行为改变的发生之间没有相关性。只有较小年龄的受试者与术后NBCs的发生有关。

结论：根据该队列研究结果，在术前使用可乐定或咪达唑仑治疗的儿童中，高度的麻醉诱导前焦虑似乎与术后消极行为改变无关。

原始文献来源 ：  

Zickerman C, Brorsson C, Hultin M, Johansson G, Winsö O, Haney M. Preoperative anxiety level is not associated with postoperative negative behavioral changes in premedicated children. Acta Anaesthesiol Scand. 2023 Mar 16. doi: 10.1111/aas.14240. 

英文原文

Comparison of the Effect of Propofol and Dexmedetomidine on Hemodynamic Parameters and Stress Response Hormones During Laparoscopic Cholecystectomy Surgery

Abstract 

Background: General anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect the endocrine system by changing the level of stress hormones and hemodynamic variables of the patient.

Objectives: The purpose of this study was to compare the effects of propofol and dexmedetomidine on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery.

Methods: Seventy patients of elective LC were included in this study. The patients were randomly assigned into two equal groups of propofol (75 µg/kg/min) and dexmedetomidine (0.5 µg/kg/hour) as anesthesia maintenance. Hemodynamic parameters (heart rate and mean atrial pressure), blood sugar, and serum epinephrine level were monitored and recorded from pre-anesthesia period to 10 min after entry to post-anesthesia care unit (PACU) according to a planned method.

Results: Heart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P < 0.001). Also, the rises in blood glucose and serum epinephrine levels in the dexmedetomidine group were significantly higher than in the propofol group (P < 0.001).

Conclusions: Anesthesia maintenance by dexmedetomidine showed a significant difference in hemodynamic parameters in comparison with propofol. While dexmedetomidine had better effects on controlling hemodynamic parameters, propofol showed better effects on decreasing stress hormones, and it can be suggested for LC surgery.

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