右美托咪定对儿童术后行为改变的影响：随机对照试验
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The effect of dexmedetomidine on postoperative behaviour change in children: a randomised controlled trial
背景与目的
全身麻醉后，儿童的行为可能会发生改变，出现一些不良行为，包括发脾气、做噩梦，以及睡眠和饮食失调。本研究旨在探讨右美托咪定是否能降低2~7岁儿童日间手术麻醉后不良行为改变的发生率。
方 法
患儿被随机分为三组：术前用药组接受2 μg.kg-1右美托咪定滴鼻；术中用药组静脉注射右美托咪定1 μg.kg-1；对照组。主要结果是使用门诊手术住院后行为调查问卷(PHBQ-AS)和优势与困难调查问卷(SDQ)评估术后第3天不良行为的发生率。次要结果包括：术后第14天和28天的不良行为发生率、诱导时焦虑、出现谵妄、疼痛、康复时间和住院时间，以及任何不良反应。
结 果
本研究对247例患儿的临床资料进行了分析。用PHBQ-AS（分别为47%、44%和51%；校正p=0.99）和SDQ（中位数评分分别为7.5、6.0和8.0；校正p=0.99）评估三组患儿术后第3天的不良行为改变相似。术中使用右美托咪定组术后第28天的不良行为发生率较低（术中用药组15%、术前用药组36%、对照组41%，p<0.001）。
结 论
综上所述，右美托咪定并不能减少2 ~ 7岁儿童日间手术后第3天的不良行为发生率。
原始文献来源及摘要
Lee-Archer PF, von Ungern-Sternberg BS, Reade M, et al. The effect of dexmedetomidine on postoperative behaviour change in children: a randomised controlled trial.[J].Anaesthesia. 2020 Jun 13. doi: 10.1111/anae.15117.
Summary
Children may develop changes in their behaviour following general anaesthesia. Some examples of negative behaviour include temper tantrums and nightmares, as well as sleep and eating disorders. The aim of this study was to determine whether dexmedetomidine reduces the incidence of negative behaviour change after anaesthesia for day case surgery in children aged two to seven years.
Children were randomly allocated to one of three groups: a premedication group received 2 mg.kg-1 intranasal dexmedetomidine; an intra-operative group received 1 mg.kg-1 intravenous dexmedetomidine; and a control group. The primary outcome was the incidence of negative behaviour on postoperative day 3 using the Post-Hospitalisation Behaviour Questionnaire for Ambulatory Surgery (PHBQ-AS) and the Strength and Difficulties Questionnaire (SDQ). Secondary outcomes included: the incidence of negative behaviour on postoperative days 14 and 28; anxiety at induction; emergence delirium; pain; length of recovery and hospital stay; and any adverse events.
The data for 247 patients were analysed. Negative behaviour change on postoperative day 3 was similar between all three groups when measured with the PHBQ-AS (47%, 44% and 51% respectively; adjusted p=0.99) and the SDQ (median scores 7.5, 6.0 and 8.0 respectively; adjusted p=0.99). The incidence of negative behaviour in the group who received dexmedetomidine intra-operatively was less at postoperative day 28 (15% compared with 36% in the dexmedetomidine premedication group and 41% in the control group, p<0.001).
We conclude that dexmedetomidine does not reduce the incidence of negative behaviour on postoperative day 3 in two to seven-year olds having day case procedures.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：冯玉蓉 审校：曹莹