摘要
目的 探讨优化围术期麻醉管理联合咪达唑仑对术前开放通路失败扁桃体切除术患儿术后躁动的防治效果。方法 选择2019年1~3月拟行扁桃体切除术患儿60例,随机分为观察组和对照组,每组30例。观察组采用优化围术期麻醉管理措施及术前给予咪达唑仑,术后采用镇痛和安抚以预防术后苏醒期躁动;对照组仅采用术后镇痛和安抚以预防术后苏醒期躁动的发生。对比2组拔管至出麻醉复苏室(PACU)躁动情况、各项麻醉苏醒指标、术后不同时间点疼痛视觉模拟(VAS)评分及Ramsay评分、术后行为量表(PHBQ)评分及行为改变发生率和麻醉不良反应。结果 观察组拔除喉罩后5 min、拔除喉罩后15 min、出PACU前的躁动发生率明显低于对照组(P<0.05);观察组术后苏醒时间、自主呼吸恢复时间、拔管时间与对照组比较差异无统计学意义(P>0.05),但观察组PACU停留时间、躁动持续时间明显短与对照组,PAED躁动评分明显低于对照组(P<0.05);观察组入PACU即刻、入PACU 15 min、入PACU 30 min、入PACU 60 min的VAS评分明显低于对照组,且Ramsay评分明显高于对照组(P<0.05);观察组术后1 d、术后1周的PHBQ评分明显低于对照组,且行为改变率明显低于对照组(P<0.05);观察组恶心呕吐、头晕、头痛等不良反应发生率与对照组比较差异无统计学意义(P>0.05)。结论 优化围术期麻醉管理联合咪达唑仑对术前开放通路失败扁桃体切除术患儿术后躁动的防治效果显著,可明显降低术后躁动发生率,缩短PACU停留时间,减轻术后疼痛及镇静程度,对术后麻醉苏醒效果无明显影响,对术后行为影响较轻,能改善患儿预后,具有较高安全性及有效性。
Objective To investigate the effects of optimized perioperative anesthetic management combined with midazolam in the prevention and treatment of postoperative agitation in children with failed open access before tonsillectomy.Methods A total of 60 children who undrwent tonsillectomy in our hospital from January 2019 to March 2019 were enrolled in the study,who were randomly divided into observation group and control group,with 30 cases in each group.The patients in observation group were treated by optimized perioperative anaesthesia management measures and oral midazolam before operation,followed by analgesia and pacification after operation to prevent restlessness during postoperative recovery.The patients in control group were treated only by postoperative analgesia and pacification to prevent the incidence of restlessness during postoperative recovery.The agitation status from extubation to anaesthesia resuscitation room(PACU),various anaesthesia recovery indexes,VAS and Ramsay scores in different time points,postoperative behavior rating scales(PHBQ)scores,incidence of behavioral changes,and adverse reactions were observed and compared between the two groups.Results The incidence rates of restlessness at 5min and 15min after laryngeal mask airway was pulled out,going out from PACU in observation group were significantly lower than those in control group(P<0.05).There were no significant differences in postoperative recovery time,spontaneous breathing recovery time and extubation time between the two groups(P>0.05).However,the PACU residence time and agitation duration in observation group were significantly shorter than those in control group,moreover the PAED agitation scores in observation group were significantly lower than those in control group(P<0.05).The VAS scores on immediately into PACU,at 15min,30min,60min after going into PACU in observation group were significantly lower than those in control group,however the Ramsay scores in observation group were significantly higher than those in control group(P<0.05).The PHBQ scores at 1d and 1w after operation in observation group were significantly lower than those in control group,and the incidence rate of behavior change in observation group was significantly lower than that in control group(P<0.05).However there were no significant differences in the incidence rates of adverse reactions including nausea,vomiting,dizziness and headache between the two groups(P>0.05).Conclusion The effects of optimized perioperative anesthesia management combined with midazolam in prevention and treatment of postoperative agitation in patient with failed open access before tonsillectomy are significant,which can obviously reduce the incidence of postoperative agitation,shorten the PACU residence time,relieve the postoperative pain,so as to improve the prognosis of patient,which is of high safety and effectiveness.
作者
吴艳红
吴志娟
王会瑟
WU Yanhong;WU Zhijuan;WANG Huise(Baoding Hospital for Maternal and Child Health,Hebei,Baoding 071000,China;不详)
出处
《河北医药》
CAS
2022年第13期2028-2031,共4页
Hebei Medical Journal
基金
保定市科学技术研究与发展计划项目(编号:18ZF318)。
关键词
儿童
扁桃体切除术
开放通路失败
七氟烷吸入麻醉
优化围术期麻醉管理
咪达唑仑
术后躁动
防治效果
术后行为改变
children
tonsillectomy
open access failure
sevoflurane inhalation anesthesia
optimize perioperative anesthesia management
midazolam
postoperative agitation
control effect
postoperative behavior change
