摘要
目的评价地佐辛对患儿七氟醚复合麻醉恢复期躁动的影响。方法择期行扁桃体及腺样体切除术的阻塞性呼吸睡眠综合征患儿90例，ASA分级Ⅰ或Ⅱ级，年龄3～6岁，体重14～31kg，性别不限，采用随机数字表法，将患儿分为3组（n=30）：芬太尼组（F组）、地佐辛组（D组）和对照组（C组）。吸入8％七氟醚，静脉注射阿曲库铵0．5mg／kg和瑞芬太尼1μg／kg行麻醉诱导；术中吸入2％～3％七氟醚，并持续静脉输注瑞芬太尼0．1～1．0μg·kg^-1·min^-1维持麻醉。手术结束前10min，F组、D组和C组分别静脉注射芬太尼2μg／kg、地佐辛0．05mg／kg和等容量生理盐水，术毕立即停止吸入七氟醚。记录拔管时间、麻醉后恢复室（PACU）停留时间；PACU期间记录躁动发生情况、持续时间，采用患儿麻醉苏醒期躁动量化评分表（PAED）评分评价躁动程度。患儿入PACU即刻（R）及15min（L）、30min（R）时行东安大略儿童医院疼痛评分量表（CHEOPS）评分和Ramsay评分分别评价疼痛程度和镇静程度。记录术后24h内患儿不良反应（如呼吸抑制、恶心、呕吐等）的发生情况。结果与C组比较，F组和D组躁动发生率和PEAD评分降低，躁动持续时间缩短，F组术后各时点CHEOPS评分降低，T1时Ramsay评分升高，D组术后各时点CHEOPS评分降低，Ramsay评分升高（P〈0．05）；与F组比较，D组躁动发生率及PEAD评分降低，术后各时点CHEOPS评分降低，T2时Ramsay评分升高（P〈0．05），躁动持续时间差异无统计学意义（P〉0．05）；3组拔管时间及PACU停留时间比较差异无统计学意义（P〉0．05）。结论0．5mg／kg地佐辛可安全有效地预防患儿七氟醚麻醉苏醒期躁动的发生，且效果优于芬太尼。
Objective To investigate the effect of dezocine on emergence agitation （EA） during recovery from sevoflurane-based anesthesia in children. Methods Ninety ASA Ⅰ or Ⅱ children, aged 3-6 yr, weighing 14-31 kg, were randomized into 3 groups （ n = 30 each） ： fentanyl group （group F）, dezoeine group （group D） and control group （group C）. Anesthesia was induced with inhalation of 8% sevoflurane and iv injection of atracurium 0.5 mg/kg and remifentani] 1 μg/kg and maintained with inhalation of 2 %-3 % sevoflurane and infusion of remifentani] at 0.1-1.0 μg· kg^- 1 . min^-1 . In groups F, D and C, fentanyl 2 μg/kg, dezoeine 0.05 mg/kg and the equal volume of normal saline were injected intravenously 10 min before the end of surgery, respectively, and inhalation of sevoflurane was stopped at the end of operation. The extubation time and length of stay in the postanesthesia care unit （PACU） were recorded. Agitation and the duration were recorded when the children were in PACU. The degree of EA was assessed using the Pediatric Anesthesia Emergence Delirium （PAED） scale. Pain was evalu- ated using the Children＇s Hospital of Eastern Ontario Pain Scale （CHEOPS） and sedation was measured with Ramsay score. The complications such as respiratory depression, postoperative nausea and vomiting were recorded within 24 h after operation. Results Compared with group C, the incidence of EA and PAED scores were significantly decreased and the duration of EA was shortened in groups F and D, CHEOPS scores were decreased at each time point after operation and Ramsay scores were increased at T1 in group F, and CHEOPS scores were decreased and Ramsay scores were increased at each time point after operation in group D （ P 〈 0.05） . Compared with group F, the incidence of EA and PAED scores were significantly decreased, CHEOPS scores were decreased at each time point after operation, and Ramsay scores were increased at T2 （ P 〈 0.05）, and no significant change was found in the duration of EA in group D （ P 〉 0.05） . There was no significant difference in the extubation time and length of stay in the PACU between the three groups （ P 〉 0.05 ）. Conclusion Dezocine 0.05 mg/kg can safely and effectively prevent EA during recovery from sevoflurane-based anesthesia in children and produces better efficacy than fentanyl.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2012年第12期1425-1428,共4页
Chinese Journal of Anesthesiology
关键词
麻醉药
吸入
烦躁
麻醉恢复期
儿童
地佐辛
Anesthetics, inhalation
DYSPHORIA
Anesthesia recovery period
Child
Dezocine
