2023 年第 8 期 第 18 卷

右美托咪定对机器人辅助腹腔镜下婴儿肾盂成形术后苏醒期谵妄的影响

Effect of dexmedetomidine on emergence delirium after robotic-assisted laparoscopic infant pyeloplasty

作者：卢彦1马丽2郭文治2郭航2金沐1

英文作者：Lu Yan1 Ma Li2 Guo Wenzhi2 Guo Hang2 Jin Mu1

单位：1首都医科大学附属北京友谊医院麻醉科，北京100050；2解放军总医院第七医学中心麻醉科，北京100700

英文单位：1Department of Anesthesiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China; 2Department of Anesthesiology the Seventh Medical Center of PLA General Hospital Beijing 100700 China

关键词：苏醒期谵妄；右美托咪定；机器人辅助腹腔镜肾盂成形术

英文关键词：Emergencedelirium;Dexmedetomidine;Robotic-assistedlaparoscopicpyeloplasty

• 摘要：

• 目的 观察右美托咪定对机器人辅助腹腔镜下婴儿肾盂成形术后苏醒期谵妄（ED）的影响。方法 选取解放军总医院第七医学中心2021年5月至2022年12月小儿泌尿外科收治的先天性肾积水患儿作为研究对象，研究中剔除相关患儿后最终78例入组，采用随机数字表法将患儿分为观察组和对照组，各39例。2组患儿麻醉诱导方案一致，观察组麻醉诱导后静脉给予右美托咪定负荷剂量1 μg/kg持续泵注10 min，随后以0.5 μg/（kg·h）持续泵注至手术结束前30 min；对照组同时间给予等容量0.9%氯化钠注射液。主要观察指标是利用康奈尔儿童谵妄量表（CAPD）评估患儿拔除气管导管后30 min内ED的发生率。次要观察指标包括患儿一般情况、围手术期指标及不良反应发生情况。结果 2组患儿性别分布、年龄、身高、体质量差异均无统计学意义（均P＞0.05）。观察组CAPD评分及ED发生率均低于对照组［（7.7±2.0）分比（9.1±2.5）分、15.4%（6/39）比38.5%（15/39）］，差异均有统计学意义（均P<0.05）。观察组术中芬太尼用量少于对照组，拔管时间、麻醉恢复室停留时间均长于对照组，气腹1、2 h动脉血乳酸水平低于对照组，差异均有统计学意义（均P＜0.05）。观察组术后恶心、呕吐、心动过缓发生率与对照组比较差异均无统计学意义（均P＞0.05）。结论 右美托咪定能够降低机器人辅助腹腔镜下婴儿肾盂成形术后ED的发生率，减少阿片类药物用量，降低术中动脉血乳酸值，但延长了拔管时间。

• Objective To observe the effect of dexmedetomidine on emergence delirium(ED) after robotic-assisted laparoscopic infant pyeloplasty. Methods  From May 2021 to December 2022, 78 children with congenital hydronephrosis admitted to Department of Pediatric Urology, the Seventh Medical Center of PLA General Hospital were selected as the study subjects. The children were divided into the observation group and the control group by the random number table method, with 39 cases in each group. The induction of anaesthesia was the same in two groups, with dexmedetomidine given intravenously at a loading dose of 1 μg/kg for 10 min after induction of anaesthesia, followed by a continuous infusion of 0.5 μg/(kg·h) until 30 min before the end of the operation in the observation group; the control group was given an equal volume of 0.9% sodium chloride injection at the same time. The main outcome measure was the incidence of ED within 30 min after tracheal catheter removal evaluated by the Cornell Assessment of Pediatric Delirium(CAPD). Secondary observation indicators included the general condition of children, perioperative indicators, and incidence of adverse reactions. Results There were no statistically significant differences in gender, age, height, and body mass between the two groups (all P>0.05). The CAPD score and ED incidence rate in the observation group were lower than those in the control group［(7.7±2.0) vs (9.1±2.5), 15.4%(6/39) vs 38.5%(15/39)］(both P<0.05). The amount of fentanyl used during surgery in the observation group was less than that in the control group, and the extubation time and anesthesia recovery room stay time were longer than those in the control group; the arterial blood lactate levels at 1 and 2 h of pneumoperitoneum were lower than those in the control group (all P<0.05). There were no statistically significant differences in the incidences of postoperative nausea, vomiting, and bradycardia between the observation group and the control group (all P>0.05). Conclusion Dexmedetomidine reduces the incidence of ED after robotic-assisted laparoscopic pyeloplasty in infants, and decreases opioid dosage and intraoperative arterial blood lactate values, but prolonged extubation time.