Comparison of sedative and analgesic effects of ketamine-propofol combination with ketamine-dexmedetomidine during tooth extraction in children with dental anxiety
-
摘要:
目的 探讨氯胺酮联合丙泊酚与氯胺酮联合右美托咪定两种镇痛方案在牙科焦虑症儿童拔除期间的镇静镇痛效果比较。 方法 选取2016年9月~2017年9月南方医科大学口腔医院口腔颌面外科收治的60例患有牙科焦虑症并拟行上颌埋伏多生牙拔除的儿童为研究对象,采用随机数字法分为2组,氯胺酮-丙泊酚组(KP组,氯胺酮:1 mg/kg+丙泊酚:1 mg/kg静脉给药),氯胺酮-右美托咪定组(KD组,氯胺酮:1 mg/kg+右美托咪定0.5 μg/kg静脉给药),每组30人。记录术前和术后焦虑评分、术后疼痛评分、麻醉恢复评分、外科医生满意度(不良/中等/良好)、需要的额外药物、手术时间、拔牙数量及不良事件。同时在麻醉药物诱导后,每5 min记录SBP/DBP,HR,RR,RSS和SPO2值,记录2 h。 结果 KP组及KD组在各个时间点心率、无创血压、药物重复次数、手术持续时间、麻醉恢复时间、镇静评分、手术前和术后焦虑评分、术后疼痛评分差异均无统计学意义(P>0.05)。KD组恶心呕吐发生率明显高于KP组(P<0.05)。KP组的外科医生满意度高于KD组,差异具有统计学意义(P<0.001)。 结论 KP组和KD组在镇静镇痛作用上差异不大。但KP组较KD组恶心呕吐发生率更低,且外科医生满意度更高。KP组可能是牙科焦虑症儿童上颌埋伏多生牙拔除术中比较满意的镇静镇痛方案选择。 Abstract:Objective To investigate the sedative and analgesic effects of ketamine-propofol combination and ketamine-dexmedetomidine in the extraction of children with dental anxiety Methods The study was conducted at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Southern Medical University, Guangzhou, China, from September 2016 to September 2017, and comprised children who were due to undergo extraction of embedded supernumerary teeth in maxillary anterior. Of the 60 participants, there were 30 (50%) in each group. Further, the ketamine-propofol group received 1mg/kg of ketamine and propofol, and the ketamine-dexmedetomidine group received 1mg/kg of ketamine + 0.5 μg/kg of dexmedetomidine. Preoperative and postoperative anxiety scores, postoperative pain scores, anesthesia recovery scores, surgeon satisfaction (bad/medium/good), additional medication required, operative time, number of extractions, and adverse events were recorded At the same time, SBP/DBP, HR, RR, RSS and SPO2 values were recorded every 5 min after induction of anesthetic drugs and recorded for 2 hours. Results No statistically significant differences were found in terms of heart rate, non-invasive blood pressures, duration of operation, anesthesia recovery time, sedation score, preoperative and postoperative anxiety score, postoperative pain score at any time and the number of drug repetitions (p>0.05). Nausea-vomiting was statistically higher in the ketamine-dexmedetomidine group (p<0.05). Conclusion There was no significant difference in sedative and analgesic effects between ketamine-propofol group and ketamine-dexmedetomidine group. However, ketamine-propofol had a lower rate of nausea and vomiting than ketamine-dexmedetomidine group, and the surgeon's satisfaction was higher. Combination of ketamine and propofol may be a satisfactory choice in the extraction of maxillary impacted supernumerary teeth in children. -
Key words:
- dexmedetomidine /
- ketamine /
- propofol /
- embedded supernumerary /
- teeth
-
表 1 两组基本资料、拔除牙齿数量、手术持续时间、外科医生的满意度及麻醉恢复时间比较(n=30)
指标 KP组 KD组 P 年龄(岁,Mean±SD) 6.17±1.1 6.23±1.3 0.298 体质量(kg,Mean±SD) 19.7±4.5 20.9±7.1 0.416 手术时间(min,Mean±SD) 12.8±1.2 11.5±2.6 0.616 恢复时间(min,Mean±SD) 13.4±6.8 16.6±9.8 0.175 手术满意度(差/中/好) 0/4/26 8/8/14 < 0.001 拔牙数量 1/2/3 8/6/7 5/11/16 0.336 表 2 两组术前、术后焦虑评分及疼痛评分的比较(n=30)
指标 KP组 KD组 P 术前焦虑评分 安静/可以放心/不能放心/哭泣和抵抗 23/4/3/0 22/5/3/0 0.936 术后焦虑评分 安静/可以放心/不能放心/哭泣和抵抗 24/2/4/0 21/4/5/0 0.613 PACU疼痛评分 (1/2/3) 29/1/0 30/0/0 1.00 术后1h疼痛评分 (1/2/3) 27/3/0 27/3/0 1.00 PACU: Post-anaesthesia care unit. -
[1] 张小敏, 施小彤. 牙科焦虑症的研究进展[J]. 广西医科大学学报, 2010, 27(1): 158-60 doi: 10.3969/j.issn.1005-930X.2010.01.067 [2] 郁 葱. 口腔门诊镇静镇痛治疗的争议与展望[J]. 华西口腔医学杂志, 2015, 33(6): 561-4 [3] Brunick A, Clark M. Nitrous oxide and Oxygen sedation: an update[J]. Dent Assist, 2010, 79(1): 22-3 [4] Roelofse JA, Shipton EA, de la Harpe CJ, et al. Intranasal sufentanil/midazolam versus ketamine/midazolam for analgesia/sedation in the pediatric population prior to undergoing multiple dental extractions under general anesthesia: a prospective, double-blind, randomized comparison[J]. Anesth Prog, 2004, 51(4): 114-21 [5] 刘俊杰, 赵 俊. 现代麻醉学[M]2版. 北京: 人民卫生出版社, 1997: 296. [6] 邢春花, 严美新. 小儿静脉泵注丙泊酚氯胺酮麻醉的临床观察[J]. 临床麻醉学杂志, 2003, 26(8): 497-9 doi: 10.3969/j.issn.1004-5805.2003.08.023 [7] Cockshott ID, Roth SH, Balsle S, et al. Pharmacokinetics of propofol in female patients[J]. Br J Anaesth, 1987, 9(5): 1103-9 [8] Kestall J, Bennett HZ, Forestier F, et al. Total intravenous anesthesia for military surgery[J]. Anaesthesia, 1988, 43(1): 46-50 doi: 10.1111/ana.1988.43.issue-1 [9] 蔡慧明, 韩平平, 周美艳, 等. 右美托咪定对氯胺酮镇痛及催眠的增强作用[J]. 中国药理学与毒理学杂志, 2011, 25(6): 547-50 doi: 10.3867/j.issn.1000-3002.2011.06.005 [10] Hosey MT, Blinkhorn AS. An evaluation of four methods of assessing the behaviour of anxious child dental patients[J]. Int J Paediatr Dent, 1995, 5(2): 87-95 [11] 钟映玉, 肖百芳, 黄寿新, 等. 脑电双频指数结合Ramsay, SAS评分对机械通气患者镇静的监测评价[J]. 海南医学, 2017, 28(22): 3720-2 doi: 10.3969/j.issn.1003-6350.2017.22.035 [12] Canpolat DG, Esmaoglu A, Tosun Z, et al. Ketamine-Propofol vs Ketamine-Dexmedetomidine combinations in pediatric patients undergoing burn dressing changes[J]. J Burn Care Res, 2012, 33(6): 718-22 doi: 10.1097/BCR.0b013e3182504316 [13] 陈碧艳, 袁启洪, 王景泉, 等. 麻醉恢复评分在全身麻醉下治疗儿童龋齿中的应用[J]. 全科护理, 2017, 15(24): 3007-9 doi: 10.3969/j.issn.1674-4748.2017.24.029 [14] Almerader N, Passriello M, Coccetti BA, et al. Premedication in children: a comparison of oral midazolam and oral clonidine[J]. Paediatr Anaesth, 2007, 17(12): 1143-9 doi: 10.1111/pan.2007.17.issue-12 [15] Tripathi M, Sahu JN, Ganesan P, et al. Effect of temperature on dielectric properties and penetration depth of oil palm shell (OPS) and OPS char synthesized by microwave pyrolysis of OPS[J]. Fuel, 2015, 153(3): 257-66 [16] Tosun Z, Akin A, Guler G, et al. Dexmedetomidine-ketamine and propofol-ketamine combinations for anesthesia in spontaneously breathing pediatric patients undergoing cardiac catheterization[J]. J Cardiothorac Vasc Anesth, 2006, 20(4): 515-9 doi: 10.1053/j.jvca.2005.07.018 [17] Koruk S, Mizrak A, Ugur BK, et al. Propofol/dexmedetomidine and propofol/ketamine combinations for anesthesia in pediatric patients undergoing transcatheter atrial septal defect closure: a prospective randomized study[J]. Clin Ther, 2010, 32(4): 701-9 doi: 10.1016/j.clinthera.2010.04.010 [18] Goyal R, Singh S, Shukla RN, et al. Ketodex, a combination of dexmedetomidine and ketamine for upper gastrointestinal endoscopy in children: a preliminary report[J]. J Anesth, 2013, 27(3): 461-3 doi: 10.1007/s00540-012-1538-8 [19] Kim HS, Kim JW, Jang KT, et al. Initial experience with dexmedetomidine for dental sedation in children[J]. J Clin Pediatr Dent, 2013, 38(1): 79-81 doi: 10.17796/jcpd.38.1.w86t8k7r51k72617 [20] Potts AL, Anderson BJ, Holford NH, et al. Dexmedetomidine hemodynamics in children after cardiac surgery[J]. Paediatr Anaesth, 2010, 20(5): 425-33 doi: 10.1111/pan.2010.20.issue-5 [21] Dexmedetomidine TJ. Ketamine: an effective alternative for procedural sedation[J]. Pediatr Crit Care Med, 2012, 13(4): 423-7 doi: 10.1097/PCC.0b013e318238b81c [22] Alletag MJ, Auerbach MA, Baum CR. Ketamine, propofol and ketofol use for pediatric sedation[J]. Pediatr Emerg Care, 2012, 28(12): 1391-5 doi: 10.1097/PEC.0b013e318276fde2 [23] Su F, Hammer GB. Dexmedetomidine: pediatric pharmacology, clinical uses and safety[J]. Expert Opin Drug Saf, 2011, 10(1): 55-66 doi: 10.1517/14740338.2010.512609
计量
- 文章访问数: 740
- HTML全文浏览量: 346
- PDF下载量: 12
- 被引次数: 0