Liang Bing, Wu Ru, Lou Yanfang
Department of Anesthesiology, Pediatric Hospital of Fudan University Shanghai 201102, China.
Department of Anesthesiology, Shanghai Geriatric Medical Center Shanghai 201102, China.
Am J Transl Res. 2025 Mar 15;17(3):2188-2196. doi: 10.62347/TWCY6801. eCollection 2025.
To investigate the effects of different doses of dexmedetomidine on delirium and hemodynamics after plasma resection of adenoids in children.
A retrospective analysis was conducted on the clinical data of 80 children who underwent plasma adenoidectomy of tonsil at the Pediatric Hospital of Fudan University from January 2022 to December 2023. The patients were divided into normal saline group, 0.1 μg/kg dexmedetomidine group, and 0.5 μg/kg dexmedetomidine group according to the dose of dexmedetomidine injected intravenously. Hemodynamic changes, modified Yale Preoperative Anxiety Scale (mYPAS-SF) scores, pharyngeal pain (at rest and during swallowing), coagulation function, and postoperative adverse reactions were compared at T0, 10 min after dexmedetomidine pumping (T1), extubation (T2), recovery (T3), 2 h after returning to ward (T4), 12 h after returning to ward (T5) and 24 h after returning to ward (T6), respectively.
There were no significant differences in extubation time, recovery time, or unguardianship time among the three groups (>0.05). The incidence of postoperative delirium was significantly lower in the 0.1 μg/kg dexmedetomidine group and 0.5 μg/kg dexmedetomidine group compared to the normal saline group (P<0.05), with the 0.5 μg/kg group showing better results. At T2, heart rate (HR) and mean arterial pressure (MAP) levels were significantly lower in 0.1 μg/kg group and 0.5 μg/kg dexmedetomidine group than those in normal saline group (P<0.05). The mYPAS-SF score was significantly lower in the 0.1 μg/kg group and 0.5 μg/kg dexmedetomidine groups than that of the normal saline group at T3, T4 and T5 (P<0.05). The score of pharyngeal pain during swallowing was significantly lower in the 0.5 μg/kg dexmedetomidine group at T5 than that of the normal saline group and 0.1 μg/kg dexmedetomidine group (P<0.05). Coagulation values (PT, APTT, and TT) were significantly altered 36 hours post-surgery, with PT, APTT, and TT increasing, while fibrinogen (FIB) decreased (P<0.05). Postoperative nasopharyngeal hemorrhage occurred in one case and nausea/vomiting in two cases in the saline group. No anesthesia-related adverse reactions were observed in the dexmedetomidine group.
Intravenous injection of 0.5 μg/kg dexmedetomidine during plasma resection of tonsillar adenoids can reduce the incidence of postoperative delirium, stabilize hemodynamics, relieve postoperative anxiety and pharyngeal pain, with minimal impacts on coagulation function. Additionally, it reduces the incidence of adverse reactions, making it a promising option for clinical use.
探讨不同剂量右美托咪定对小儿腺样体等离子切除术后谵妄及血流动力学的影响。
回顾性分析2022年1月至2023年12月在复旦大学附属儿科医院行扁桃体腺样体等离子切除术的80例患儿的临床资料。根据静脉注射右美托咪定的剂量将患者分为生理盐水组、0.1μg/kg右美托咪定组和0.5μg/kg右美托咪定组。分别于T0（右美托咪定泵注前）、右美托咪定泵注后10分钟（T1）、拔管时（T2）、苏醒时（T3）、返回病房后2小时（T4）、返回病房后12小时（T5）和返回病房后24小时（T6）比较血流动力学变化、改良耶鲁术前焦虑量表（mYPAS-SF）评分、咽痛（静息时和吞咽时）、凝血功能及术后不良反应。
三组患者的拔管时间、苏醒时间或无监护时间差异均无统计学意义（>0.05）。0.1μg/kg右美托咪定组和0.5μg/kg右美托咪定组术后谵妄发生率明显低于生理盐水组（P<0.05），0.5μg/kg组效果更佳。在T2时，0.1μg/kg组和0.5μg/kg右美托咪定组的心率（HR）和平均动脉压（MAP）水平明显低于生理盐水组（P<0.05）。在T3、T4和T5时，0.1μg/kg组和0.5μg/kg右美托咪定组的mYPAS-SF评分明显低于生理盐水组（P<0.05）。在T5时，0.5μg/kg右美托咪定组吞咽时咽痛评分明显低于生理盐水组和0.1μg/kg右美托咪定组（P<0.05）。术后36小时凝血指标（PT、APTT和TT）明显改变，PT、APTT和TT升高，而纤维蛋白原（FIB）降低（P<0.05）。生理盐水组术后发生1例鼻咽部出血，2例恶心/呕吐。右美托咪定组未观察到与麻醉相关的不良反应。
扁桃体腺样体等离子切除术期间静脉注射0.5μg/kg右美托咪定可降低术后谵妄发生率，稳定血流动力学，缓解术后焦虑和咽痛，对凝血功能影响最小。此外，它还降低了不良反应的发生率，是一种很有前景的临床应用选择。
