【罂粟摘要】右美托咪定预防七氟醚麻醉患儿出现谵妄和术后行为改变:一项双盲随机试验

右美托咪定预防七氟醚麻醉患儿出现谵妄和术后行为改变:一项双盲随机试验

贵州医科大学麻醉与心脏电生理课题组

翻译：王璐   

编辑：宋雨婷 

审校：曹莹

目的

突发性谵妄(ED)是一种常见的神经系统并发症，不仅困扰着早期麻醉后儿童及其家庭，但长期来看也会对儿童产生不利影响，本研究旨在探讨单剂量右美托咪定对七氟醚麻醉患儿突发性谵妄的影响，并通过长期随访观察术后行为改变。

方法

年龄2-7岁，美国麻醉师学会(ASA) I级或II级，计划扁桃体切除术伴或不伴腺样体切除术的患者在麻醉诱导后10分钟内随机接受右美托咪定0.5µg/kg (D组)或容量匹配的生理盐水(C组)。主要结局指标拔管后30分钟内ED的发生率。其他结局指标包括疼痛发生率、拔管时间、拔管后麻醉后恢复室(PACU)住院时间、不良事件和术后不良行为改变的发生率。

结果

90名儿童完成了这项研究。与对照组(C组)相比，右美托咪定降低ED发生率(31.1%比53.3%；P =0.033)和疼痛(28.9%比57.8%；P =0.006)，但延长拔管时间(P ≤0.001)。两组患者拔管后PACU停留时间及不良事件发生率相似。D组不良行为改变的发生率在出院后1天和7天显著降低(33.3%比60.0%；P =0.011%和24.4%比46.7%；P =0.028)显著高于C组，但第30天差异无统计学意义。

结论

右美托咪定0.5µg/kg可降低七氟醚麻醉后突发性谵妄的发生率，可用于预防术后不良反应。

原始文献来源：

Shi M, Miao S, Gu T, Wang D, Zhang H, Liu J. Dexmedetomidine for the prevention of emergence delirium and postoperative behavioral changes in pediatric patients with sevoflurane anesthesia: a double-blind, randomized trial. Drug Des Devel Ther. 2019;13:897-905. Published 2019 Mar 15. 

英文原文

Dexmedetomidine for the prevention of emergence delirium and postoperative behavioral changes in pediatric patients with sevoflurane anesthesia: a double-blind, randomized trial 

purpose: Emergence delirium (ED) is a common neurologic complication that can not only distress children and their families in the early postanesthetic period, but can also have adverse effects on children in the long-term. This study aimed to investigate the effects of single-dose dexmedetomidine on ED in children with sevoflurane anesthesia and to observe postoperative behavioral changes through long-term follow-up.

Method: Patients aged 2–7 years, American Society of Anesthesiologists class (ASA) I or II, scheduled for tonsillectomy with and without adenoidectomy were randomized to receive dexmedetomidine 0.5 µg/kg (Group D) or volume-matched normal saline (Group C) over 10 minutes after induction of anesthesia. The primary outcome was the incidence of ED within 30 minutes after extubation. Other outcomes were the incidence of pain, extubation time, post-anesthesia care unit (PACU) length of stay after extubation, adverse events, and the incidence of negative postoperative behavioral changes (NPOBCs).

Results: Ninety children completed the study. Compared with the control group (Group C), dexmedetomidine decreased the incidence of ED (31.1% vs 53.3%; P=0.033) and pain (28.9% vs 57.8%; P=0.006), but it prolonged extubation time (P≤0.001). PACU length of stay after extubation and the percentage of adverse events were similar between groups. The incidence of NPOBCs in Group D was significantly lower at 1 and 7 days after discharge (33.3% vs 60.0%; P=0.011% and 24.4% vs 46.7%; P=0.028, respectively) than it was in Group C, but no significant difference was found at the 30th day.

Conclusion:Dexmedetomidine 0.5 µg/kg reduced the incidence of ED after sevoflurane anesthesia and might be used to prevent NPOBCs.

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