摘要
目的观察羟考酮在小儿腹腔镜阑尾切除术应用的临床效果。方法选择急诊行腹腔镜阑尾切除术患儿80例,ASAⅠ～Ⅱ级,年龄6～13岁,采用随机数字表法分为2组,每组40例。S组麻醉诱导给予舒芬太尼0. 4μg·kg-1,O组给予羟考酮0. 4 mg·kg-1。所有患儿均采用静脉麻醉诱导:丙泊酚2. 5 mg·kg-1,顺苯磺酸式阿曲库铵0. 15 mg·kg-1,插入气管导管行机械通气。麻醉维持采用静吸复合。分别记录患儿诱导前(T0)、插管即刻(T1)、建立人工气腹后(T2)、阑尾切除时(T3)、手术结束(T4)、苏醒即刻(T5)和离开复苏室即刻(T6)时点的心率(HR)、收缩压(SBP)、舒张压(DBP);记录T5、T6、术后4 h(T7)和术后8 h(T8)患儿的行为量表疼痛程度(FLACC)评分及Ramsay镇静评分;记录苏醒时间及术毕患儿复苏过程中追加止痛药例数。观察患儿诱导时呛咳、术后恶心、呕吐、术后躁动、呼吸抑制等不良反应发生率。结果与S组比较,O组患儿术中血流动力学更平稳(P <0. 05),患儿拔管时间稍延长,但差异无统计学意义(P> 0. 05); O组儿童FLACC评分在T5、T6、T7时点低于S组(P <0. 05),而Ramsay镇静评分在T5、T6时点高于S组;追加止痛药的例数O组少于S组,(11例vs 23例,P <0. 05); O组患儿诱导时呛咳发生率低于S组(P <0. 05); O组术后躁动例数少于S组(12例vs 21例,P <0. 05);其他不良反应2组间差异均无统计学意义(P> 0. 05)。结论羟考酮0. 4 mg·kg-1用于小儿腹腔镜阑尾切除术诱导具有术中血流动力学平稳、术后镇痛满意,并减少了呛咳和术后躁动的发生。
AIM To observe the clinical anesthesia effect of oxycodone in pediatric patients with laparoscop- ic appendectomy. METHODS Totally 80 ASA I - I1 cases of aged 6 - 13 years old,underwent laparoscopic ap- pendectomy ,were randomly divided into 2 groups using random number table ：sufentanil group （group S）and oxyc- odone group（ group O） ,40 patients in each group. Group S anesthesia induction given sufentanil 0.4 mg · kg-1 , and group 0 given oxycodone 0.4 mg · kg^-l. Anesthesia was induced with propofol 2.5 mg · kg^-1, cisatracurium 0.15 mg·kg^-1 ,inserted the endotracheal tube and mechanical ventilation. The anesthesia maintain was given remifentanil combined with p 1 and sevoflurane. The heart rate（HR） ,systolic blood pressure（SBP） and dias- tolic blood pressure（DBP） in the time of before anesthesia induction （ To ） , immediate intubation （ T1 ）, instant of pneumoperitoneum （ T2 ） , appendix resection （ T3 ） , the end of the surgery （ T4 ） ,waking moment （ T5 ）, the moment of leaving the recovery room （ T6 ） were recorded. The face, legs, activity, cry and consolability （ FLACC ） scores and Ramsay sedation score in the time of T5 ,T6, 4 h after the operation（T7 ） ,8 h after operation（T8 ） were recorded. The waking up time ,additional analgetic cases and the adverse reactions, such as choke to cough in anesthesia in- duction,postoperative nausea and vomiting,postoperative irritability and respiration depression were also recorded. RESULTS The average HR,SBP and DBP fluctuations of the group 0 was lower than those of that of group S （ P 〈 0.05 ）. The decannulation time of group O was slightly longer than that of group S, but there was no statistical- ly significant difference（ P 〉 0.05 ）. The FLACC score of group 0 was lower than that of group S at the time of T5, T6, T7 （ P 〈 0. 05 ）. The Ramsay sedation score of group O was higher than that of group S at the time of T5, T6. The cases of requiring additional analgesia in group S and group 0 was 23 and 11 respectively （ P 〈 0.05 ）. The cases of anesthesia induced choking cough in group 0 was lower than that in group S （P 〈 0.05 ）. The rate of postoperative irritability in group O was lower than that in group S （P 〈 0. 05 ） tistically significant difference between 2 groups （ P 〉 0.05 ）. The cases of other adverse reactions were no sta- CONCLUSION Oxycodone 0.4 mg · kg-1 can be used to the pediatric laparoscopic appendectomy anesthesia induction with intraoperative hemodynamic stability, more satisfied postoperative analgesia, and can reduce the choking cough and postoperative irritability.
作者
彭文勇
祝家群
廖俊锋
杜光生
蓝志坚
PENG Wenyong;ZHU Jiaqun;LIAO Junfeng;DU Guangsheng;LAN Zhijian(Department of Anesthesiology,Jinhua Municipal Central Hospital,Jinhua 321000,China)
出处
《中国临床药学杂志》
CAS
2018年第5期307-311,共5页
Chinese Journal of Clinical Pharmacy
基金
浙江省临床科研基金项目(编号2012ZYC-A82)
