摘要
目的观察联合应用芬太尼、对乙酰氨基酚栓剂及局部浸润麻醉对唇腭裂修补术小儿全麻苏醒期镇静镇痛的效果。方法择期行唇腭裂修补术的患儿54例，随机分为2组，对照组（C组，n=28）和多模式镇痛组（M组，n=26）。均采用伞身麻醉气管插管的方法，七氟烷麻醉诱导与维持。于术歼始前由术者对两组患儿行局部浸润麻醉；M组患儿气管插管后即予对乙酰氨基酚栓剂塞肛；手术结束前10min，静脉注射静脉注射芬太尼0．5μg／kg，C组不给药。观察两组患儿停止吸入七氟烷至拔除气管导管的时间、PACU内镇静镇痛评分、PACU的滞留时间及不良反廊的发生情况。结果两组患儿从停止吸入麻醉药至拔除气管导管时间无明显差异；PACU滞留时间M组[（25±4）min]较C组[（32±3）min]短（t=7．426，P〈0．01）；与C组比较，M组忠儿镇痛满意（F=4．840，P=0.028），发生严晕疼痛（F=5.333，P=0.021）及躁动（F=4．571，P=0．033）的例数少，差异具有统计学意义；两组患儿无＋例发生呼吸抑制及瘙痒，过度镇静和恶心呕吐的发牛率，两组间差异无统计学意义。结论联合应用芬太尼、对乙酰氨基酚栓剂及局部浸润麻醉的多模式镇痛方法在苏醒期可为唇腭裂修补术小儿提供良好的镇痛镇静，减少躁动的发生率，加快PACU患者的转运速度，有利于苏醒期安全。
Objective To investigate the effects of naultimodal analgesia on analgesia and sedation during emergence of general anesthesia for cleft lip and/or palate surgery pediatric patients. Methods Fifty-four pediatric patients with ASA Ⅰ and Ⅱ cleft lip and/or palate, aged 2 - 7, undergoing prosthesis were randomly allocated into 2 groups： control group （ Group C, n = 28） inhaling nitrous oxide/oxygen （50%： 50% } and sevoflurane（5% ） for general anesthesia, and multinaodal group （Group M, n = 26）, injected intravenously with fentanyl and atracurium in addition to inhalation of nitrous oxide/oxygen （50%： 50% ） and sevof/urane（5% ）. Ventilation was controlled with PCV modal to maintain end-tidal CO2 to 35 - 45 mmHg. Local anesthesia at the surgical site was facilitated by the surgeon before the beginning of surgery. After intubation, rectal paracetamol was used for Group M（ 120 mg for 2 -4 year-olds and 325 mg for 5 -7 year-olds） and fentanyl 0.5 mg/kg was injected for postoperative analgesia 10 rain before the end of surgery. An observer who was blinded to the protocol recorded the time from the discontinuation of sevoflurane and nitrous oxide to tracheal extubation, accessed the sedation and pain scale, recorded the time ready for discharge from post-anesthesia care unit （PACU） and the incidence of adverse effects. Results The time ready for discharge from PACU of Group M was （25 4） rain, significantly shorter than that of Group C i （ 32± 3 ） nain,t = 7. 426, P 〈 0.01]. The analgesia satisfaction rate of Group M was 69.2% （ 18/ 26）, significantly higher than that of Group C [ 25.0% , 7/28, P 〈 0.05 ]. The severe pain rate of Group M was 7.7% , significantly lower than that of Group C （35.7% , F =5. 333 ,P =0. 021 ）. The agitation rate of Group Mwas 11.5%, significantly lower than that of Group C （39. 3%, F =4.571,P =0.033） .Conclusion Multimodal analgesic regimen of infiltration of local anesthetic at surgical site and rectal paracetamol and intravenous fentanyl provides sufficient analgesia, minimizes the incidence of agitation after general anesthesia in cleft lip and/or palate surgery for children, increases the slbeed of referring patients in PACU, and ensures the safety of the postanaesthetic patients.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第13期906-908,共3页
National Medical Journal of China
关键词
多模式镇痛
苏醒期躁动
小儿麻醉
唇腭裂修补术
Multimodal analgesia
Emergence agitation
Pediatric anesthesia
Cleft lip and palate surgery
