小儿动脉导管结扎手术后苏醒期躁动的药物治疗观察  

Clinical observation of recovery period agitation after the use of sevoflurane in ligation of patent ductus arteriosus in children

作　　者：夏星[1] 邱莉[2] 王学勇[2] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所综合外科ICU,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉科,100029

出　　处：《心肺血管病杂志》2014年第6期849-852,856,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：比较七氟烷和七氟烷复合瑞芬太尼或舒芬太尼麻醉,用于小儿动脉导管结扎手术,观察术后苏醒期躁动的发生情况.方法：将60例美国麻醉医师学会（ASA）分级为Ⅰ～Ⅱ级,择期行动脉导管结扎术的小儿随机分成三组,七氟烷组（F组）,七氟烷复合瑞芬太尼组（R组）和七氟烷复合舒芬太尼组（S组）.术中监测平均动脉压（MAP）、HR、SpO2.记录患儿麻醉时间、术后清醒时间和拔管时间.观察术后即刻（T0）、5分钟（T1）、10分钟（T2）、20分钟（T3）、30分钟（T4）及60分钟（T5）的躁动评分及平均动脉压（MAP）、HR和SpO2.记录拔管后Ramsay镇静评分、镇痛评分及不良反应.结果：三组患儿在年龄、体质量、麻醉时间、清醒时间和拔管时间上差异无统计学意义（P＞0.05）.术后血流动力学指标：R组、S组患儿术后各点平均动脉压（MAP）、HR明显低于F组（P＜0.05）,而SpO2差异无统计学意义.R组与S组比较,除T1、T2两时间点差异无统计学意义,S组MAP和HR均明显低于R组（P＜ 0.05）.三组患儿术后躁动的情况：与F组比较,R组与S组的躁动评分明显降低（P＜0.05）,与R组比较,除T1外,其余各时间点,S组躁动评分均明显低于R组（P＜0.05）.术后镇静、镇痛评分及不良事件发生情况：F组、R组和S组镇静满意率分别为30％、65％和90％,R组、S组的镇静满意率明显高于F组,而R组、S组两组相比,镇静满意率无明显差异.同F组相比,R组、S组的镇痛评分＞5分需术后疼痛治疗的比例明显下降,而R组、S组两组相比,＞5分的比例S组明显低于R组（P＜0.05）.三组中仅F组有2例恶心呕吐.结论：七氟烷复合瑞芬太尼或舒芬太尼麻醉效果优于单纯七氟烷吸入麻醉,可减轻苏醒期躁动.而舒芬太尼复合七氟烷麻醉对小儿动脉导管结扎术的血流动力学更稳定,手术结束后苏醒快,术后镇痛效果更好.Objective：To evaluate the effect of sevoflurane, sevoflurane combined with remifentanil or sufentanil on recovery period agitation after the operation of patent duetus arteriosus ligation in children. Methods ： Sixty ASA Ⅰ or Ⅱ children scheduled for patent duetus arteriosus ligation were randomly divided into three groups： sevoflurane group （group S ）, sevoflurane combined with remifentanil group （group R ） and sevoflurane combined with sufentanil group（groupS）. MAP, HR and SpO2 were continuously monitored during operation. The Anesthesia time, recovery time and extubation time during recovery period were recorded. Agitation scores as well as MAP, HR and SpO2 were measured at 0, 5, 10, 30 and 60 minutes post-surgery. Pain scores, Ramsay scores and adverse complications were recorded after extubation. Results：There were no significant differences in age, weight, type of surgery, time of anesthesia, recovery time and extubation time （P 〉 0. 05 ） in the three groups. Hemodynamic data： MAP and HR recorded in group R or group S were significantly lower than that in group F（P 〈 0. 05 ）. While, there were no statistical differences of SpO2 in all three groups （P 〉 0. 05）. When compared with group R, MAP and HR of group S decreased significantly except for time point T1 and T2 （ P 〈 0. 05 ）. The agitation status in the three groups ： The agitation scores in group S or group R were significantly lower than that in group F at all time points post-surgery （ P 〈 0. 05 ）. Meanwhile, the agitation scores in group S were significantly lower than that in group R except for time point T1 （P 〈 0. 05）. Pain scores, sedation scores and adverse events： The sedation satisfaction rates were 30% , 65% and 90% in group F, group R and group S respectively. The sedation satisfaction rate and pain scores in group R or group S were significantly higher than that in group F. There were no significant differences of the sedation satisfaction rate between group R and group S. Wh

关 键 词：七氟烷 瑞芬太尼 舒芬太尼 小儿 苏醒期躁动 

分 类 号：R54[医药卫生—心血管疾病]