【罂粟摘要】右美托咪定对儿童术后行为改变的影响：一项随机对照试验
右美托咪定对儿童术后行为改变的影响：一项随机对照试验
翻译：佟睿 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组
全身麻醉后，儿童的行为可能会发生变化。如出现一些负面行为，包括发脾气、做噩梦，以及睡眠和饮食障碍。本研究的目的是确定右美托咪定是否能降低2至7岁儿童日间手术麻醉后负面行为的发生率。儿童被随机分为三组:术前用药组，即接受2mg.kg-1右美托咪啶；术中用药组，即术中接受1mg.kg-1右美托咪定以及对照组。主要观察指标是术后第3天使用门诊手术住院后行为问卷(PHBQ-AS)和力量与困难问卷(SDQ)调查负面行为的发生率。次要观察指标包括：术后第14天和第28天的不良行为发生率；诱导时的焦虑情况；是否出现谵妄、痛苦；康复和住院时间以及任何不良事件的发生。我们对247例患儿的资料进行了分析。术后第3天，三组患者的负性行为变化相似(分别为47%、44%和51%；修正p=0.99)和SDQ(中位数分数分别为7.5、6.0和8.0；修正p=0.99)。术中接受右美托咪定的患者在术后第28天的不良行为发生率较低(右美托咪定术前用药组为15%，对照组为36%，p<0.001)。我们的结论是，右美托咪定不能减少接受日间手术的2至7岁儿童术后第3天的不良行为发生率。
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 sevenyear olds having day case procedures.