坐骨神经阻滞对足部矫形手术患儿七氟醚复合麻醉恢复期躁动的影响  

Effects of sciatic nerve block on emergence agitation following sevoflurane-based anesthesia in pediatric patients undergoing foot orthomorphia

作　　者：桂晓臣[1] 蒋文臣[1] 徐进[1] 张浩[1] 李平[1] 

机构地区：[1]天津医院麻醉科,300211

出　　处：《中华麻醉学杂志》2014年第5期549-551,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价坐骨神经阻滞对足部矫形手术患儿七氟醚复合麻醉恢复期躁动的影响.方法 择期行足部矫形手术患儿60例,性别不限,年龄3～7岁,体重12～20 kg,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其分为2组（n=30）：对照组（I组）和坐骨神经阻滞组（Ⅱ组）.麻醉诱导后置入喉罩,行人工辅助或机械通气.麻醉维持：吸入七氟醚,呼气末浓度0.5％ ～2.0％,静脉注射芬太尼0.5 ～ 2.0 μg/kg.麻醉诱导后采用神经刺激器辅助定位实施患侧坐骨神经阻滞,给予0.25％布比卡因0.5 ml/kg.记录喉罩拔除时间和苏醒时间,于麻醉恢复期30 min时进行躁动评分,记录躁动发生情况;于麻醉恢复期10、30 min时行改良面部疼痛评分（FPS-R）,并记录麻醉恢复期低氧血症和恶心呕吐等不良反应的发生情况.结果 与Ⅰ组比较,Ⅱ组术中芬太尼用量和平均呼气末七氟醚浓度降低,喉罩拔除时间和苏醒时间缩短,躁动发生率、FPS-R评分和低氧血症发生率降低（P＜0.05）.结论 坐骨神经阻滞有助于降低足部矫形手术患儿七氟醚复合麻醉恢复期躁动发生.Objective To evaluate the effects of the sciatic nerve block on emergence agitation following sevoflurane-based anesthesia in pediatric patients undergoing foot orthomorphia.Methods Sixty pediatric patients,aged 3-7 yr,weighing 12-20 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for elective foot orthomorphia,were randomly assigned to one of two groups （n =30 each）：control group （group Ⅰ） and sciatic nerve block group （group Ⅱ）.After induction of anesthesia,laryngeal mask airway was inserted,and artificial or mechanical ventilation was performed.Anesthesia was maintained with inhalation of sevoflurane （end-tidal concentration 0.5%-2.0%） and iv fentanyl 0.5-2.0 μg/kg.The sciatic nerve block on the affected side was performed under the guidance of a nerve stimulator,and 0.25% bupivacaine 0.5 ml/kg was injected.Laryngeal mask airway removal time and emergence time were recorded.At 30 min of recovery from anesthesia,agitation was scored and the development of emergence agitation was recorded.Pain was evaluated with Faces Pain Scale-Revised （FPS-R） at 10 and 30 min of recovery from anesthesia.Adverse reactions including hypoxemia and nausea and vomiting were also recorded during recovery from anesthesia.Results Compared with group Ⅰ,the intraoperative consumption of fen tanyl and mean end-tidal concentration of sevoflurane were significantly decreased,laryngeal mask airway removal time and emergence time were shortened,and the incidence of emergence agitation,PPS-P scores and incidence of hypoxemia were decreased in group Ⅱ.Conclusion The sciatic nerve block is helpful in decreasing the development of emergence agitation following sevoflurane-based anesthesia in pediatric patients undergoing foot orthomorphia.

关 键 词：神经传导阻滞 坐骨神经 麻醉药 吸入 麻醉恢复期 儿童 躁动 

分 类 号：R726.1[医药卫生—儿科]