术前使用右美托咪定与咪达唑仑对儿童疝修补术后焦虑的影响：一项随机对照研究
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comparison of dexmedetomidine and midazolam premedication on postoperative anxiety in children for hernia repair surgery a randomized controlled trail
背景与目的
围手术期焦虑在儿科手术患者中很常见。本研究的目的是确定在儿童疝修补术前输注右美托咪定是否比术前输注咪达唑仑能更好的缓解术后焦虑。
方 法
90名计划接受择期疝修补术年龄在6-11岁的儿童，加入这项双盲、随机对照试验。D组(45例)在麻醉诱导前10min静脉注射右美托咪啶(0.5μg/kg)，M组(45例)在麻醉诱导前静滴溶于2 0ml生理盐水的咪达唑仑(0.0 8 mg/kg)。主要结果为由改良的耶鲁术前焦虑量表测量的术后焦虑评分，次要结果包括收缩压、舒张压、心率、术后疼痛视觉模拟评定量表测量的疼痛数值和患者对数字评定量表的满意程度。
结 果
D组术后焦虑明显低于术前焦虑(术后2h平均差异[95%CI]：2.83[0.87~4.79]，P=0.036；术后4h平均差异[95%CI]：3.2 9[1.39~5.2 0]，P=0.005)。M组患者术前和术后焦虑程度无明显差异(P>0.0 5)。D组术后2 h，4h焦虑评分明显低于M组术后 2 h(平均差异[95%CI]：1.89[0.5 2~3.2 6]，P=0.0 1)和术后4h(平均差异[95%CI]：3.32[1.98~4.6 6]，P<0.001.0 1)。用药后D组收缩压、舒张压、心率均低于M组(SBP平均值[95%CI]：13.87[10.30~17.43]，P<0.001)。血压均值差异[95%CI]：5.96[3.80~8.1 1]，P<0.001；HR均值差异[95%CI]：10.36[7.5 8~13.13]，P<0.001。D组术后2h疼痛数值(中位差值[95%CI]：1[0.2 6~1.3 4]，P=0.004)，4h(中位差值[95%CI]：1[0.31~1.0 2]，P=0.0 5)。P=0.003)和1d(中位差[95%CI]：0[0.22~0.76]，P=0.003)，明显低于M组。D组患者满意度评分1 d时明显高于M组(中位差[95%CI]：0[-0.006.83~-0.2 4]，P=0.0 5)，术后1w时略高于M组(中位差[95%CI]：0[-0.6 7~-0.0 4]，P=0.0 6)。
结 论
与咪达唑仑相比，术前单次静脉注射右美托咪定似乎对当日手术的儿童能更好的缓解术后焦虑。
原始文献摘要
Background: Perioperative anxiety is common in pediatric patients undergoing surgery.
Aim: The aim of this study was to determine whether an infusion of dexmedetomidine prior to hernia repair in children provides better postoperative anxiety outcomes that a preoperative infusion of midazolam.
Methods: Ninety 6-11 year-old children, who were scheduled to undergo elective hernia repair, were enrolled for this double-blind, randomized controlled trial. Group D (n = 45) received an intravenous infusion of dexmedetomidine (0.5μg/kg) and Group M (n = 45) received an intravenous infusion of midazolam (0.08mg/kg) in 20ml of normal saline for 10min before the induction of anesthesia. Pre- and postoperative scores on the modified Yale Preoperative Anxiety Scale were the main outcomes.Secondary outcomes included systolic blood pressure, diastolic blood pressure, heart rate, postoperative pain measured on a visual analogue scale and patient satisfaction using a numerical rating scale.
Results: Postoperative anxiety in Group D was significantly lower than preoperative anxiety (2h postoperatively mean difference [95% CI]: 2.83 [0.87 to 4.79], P =0.036, 4h postoperatively mean difference [95% CI]: 3.29 [1.39 to 5.20], P =0.005). Preoperative and postoperative anxiety in Group M was similar. Anxiety scores in Group D were also significantly lower than anxiety in Group M 2 h (mean difference [95% CI]: 1.89 [0.52 to 3.26], P =0.01) and 4h (mean difference [95% CI]: 3.32 [1.98 to 4.66], P<0.001) postoperatively. Systolic blood pressure, diastolic blood pressure and heart rate were lower in Group D than in Group M after administration of sedative drugs until children left PACU (SBP mean difference [95% CI]: 13.87 [10.30 to 17.43], P < 0.001, DBP mean difference [95% CI]: 5.96[3.80 to 8.11], P < 0.001, HR mean difference [95% CI]: 10.36 [7.58 to 13.13], P < 0.001). Pain was also significantly lower in Group D than in Group M at 2h (median difference [95% CI]: 1 [0.26 to 1.34], P =0.004), 4h (median difference [95% CI]: 1 [0.31 to 1.02], P =0.003) and 1d (median difference [95% CI]: 0 [0.22 to 0.76], P =0.003) postoperatively. Patient satisfaction scores were significantly higher in Group D than in Group M 1d (median difference [95% CI]: 0 [-0.83 to -0.24], P =0.006) and somewhat higher 1w (median difference [95% CI]: 0 [-0.67 to -0.04], P = 0.06) postoperatively.
Conclusion: Compared with midazolam, a single preoperative intravenous dose of dexmedetomidine appears to provide better postoperative anxiolytic effects for children undergoing same-day surgery.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：余晓旭 编辑：何幼芹 审校：王贵龙