舒芬太尼对小儿扁桃体和腺样体摘除术术后躁动的临床观察  

Clinical efficacy of sufentanil on emergence delirium after operation of adenotonsillectomy in children

作　　者：郭文静[1] 柴军[2] 沈洁[2] 

机构地区：[1]浙江省肿瘤医院,杭州310022 [2]中国医科大学附属盛京医院麻醉科,沈阳110004

出　　处：《实用药物与临床》2013年第3期195-197,共3页Practical Pharmacy and Clinical Remedies

摘　　要：目的观察小剂量舒芬太尼在小儿扁桃体和腺样体切除手术中预防全麻术后躁动的临床效果。方法选择全麻下择期行扁桃体和腺样体切除手术的患儿60例,年龄3～7岁,随机分为2组,每组30例。诱导采用芬太尼、异丙酚和氯化琥珀胆碱。麻醉维持均是静吸复合麻醉,吸入50%笑气、1%～3%七氟醚及瑞芬太尼0.1～0.2μg/(kg.min)静脉泵入。手术结束前30 min,S组(舒芬太尼组)给予舒芬太尼0.2μg/kg静脉注射,C组(空白对照组)给予等剂量生理盐水静脉注射。记录入室(T0)、给药后(T1)、苏醒时(T2)各时间点的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2),记录拔管时间、苏醒时间(停药至呼之能应)。观察术后躁动、呼吸抑制及恶心呕吐等情况。结果两组患儿各时间点的血压、心率、血氧饱和度比较差异均无统计学意义;拔管时间和苏醒时间两组间比较差异无统计学意义(t=1.94,P>0.05);术后躁动情况S组明显比C组减轻,差异有统计学意义(t=0.84,P<0.01);两组均未发生明显呼吸抑制,C组有1例恶心呕吐。结论 0.2μg/kg舒芬太尼在手术结束前30 min静脉注射,能够抑制七氟醚全麻下小儿术后躁动,并不影响苏醒时间,也不增加呼吸抑制、恶心呕吐的发生率。Objective To evaluate the preventive effect of sufentanil on restlessness during emergence from general anesthesia in children undergoing adenotonsillectomy. Methods 60 children aged 3～7 years old undergoing selective tonsillectomy and/or adenoidectomy were allocated randomly into two groups,30 cases in each group.Both groups received anesthesia induction with fentanyl,propofol and succinylcholine chloride.50% nitrous oxide and 1%～3% sevoflurance inhalation and remifentanil 0.1～0.2 μg/（kg·min）continuous intravenous infusion was used for maintenance of anesthesia.Sufentanil 0.2 μg/kg was administered intravenously 30 min before the end of operation in sufentanial group,and the same volume normal saline was given in control group.The Mean arterial blood pressure（MAP）,Heart rate（HR）,Oxygen saturation（SpO2） at T0（after entering the operating room）,T1（after administration）and T2（awaking） were recorded.The times of extubation and awaking were recorded.The degree of restlessness during the time of palinesthesia and the adverse effects were evaluated. Results Both two groups had good hemodynamic stability at T0,T1 and T2.There was no significant difference in extubation time,waking time between the two groups（t=1.94,P〈0.05）.Group S had lower satisfaction rate of restlessness compared to group C postoperatively（t=0.84,P〈0.01）.Both groups had no respiratory inhibition.Group C had a case of nausea and vomiting. Conclusion Injection of sufentanil 0.2 μg/kg 30 min before the end of operation produces a favorable sedation effect without prolongation of extubation during the emergence,and it does not increase the incidence of respiratory depression,nausea and vomiting from general anesthesia in children.

关 键 词：舒芬太尼 小儿 术后躁动 全麻 七氟醚 

分 类 号：R726.1[医药卫生—儿科]