酮咯酸氨丁三醇预防阻塞性睡眠呼吸暂停综合征患儿全身麻醉苏醒期躁动的效果  

Effect of ketorolact tromethamine on emergence agitation during recovery from general anesthesia in children with obstructive sleep apnea syndrome

作　　者：陈艳红[1] 刁玉刚[1] 崔小鹏[1] 郎丽[1] 许霁虹[1] 

机构地区：[1]沈阳军区总医院麻醉科,辽宁沈阳110016

出　　处：《上海医学》2015年第8期619-621,共3页Shanghai Medical Journal

摘　　要：目的评价酮咯酸氨丁三醇预防阻塞性睡眠呼吸暂停综合征(OSAS)患儿全身麻醉苏醒期躁动的效果。方法择期行扁桃体和腺样体切除术的OSAS患儿80例,分入治疗组和对照组,每组40例。所有患儿均采用体积分数为0.08的七氟烷加体积分数为1的氧气,流量8~10L诱导,待患儿意识消失后开放外周静脉。麻醉诱导给予地塞米松0.1mg/kg、阿托品0.01mg/kg、丙泊酚1.5~2.0mg/kg、罗库溴铵0.6mg/kg、芬太尼2μg/kg,达到气管插管要求后插入合适的气管导管。术中静脉注射丙泊酚2~4mg·kg-1·h-1、瑞芬太尼0.05~0.25μg·kg-1·min-1,并吸入体积分数为0.01~0.025的七氟烷维持麻醉。术毕带气管导管入麻醉后恢复室,治疗组予静脉注射酮咯酸氨丁三醇0.5mg/kg,总量<15mg,对照组给予等量0.9%氯化钠溶液。记录患儿的手术时间、自主呼吸恢复时间(手术结束至自主呼吸恢复时间)、呼名睁眼时间、拔除气管导管时间、拔除气管导管后呼吸道不良事件发生情况,以及术后疼痛、躁动和恶心呕吐的发生情况。采用患儿麻醉苏醒期躁动量化评分表(PAED)评估躁动的程度,根据面部疼痛表情量表(FPS)评估术后疼痛程度。结果治疗组术后FPS评分、躁动发生率和PEAD评分均显著低于对照组(P值均<0.05),需要丙泊酚和曲马多处理的患儿比例均显著低于对照组(P值均<0.05),术后呼吸道不良事件发生率显著低于对照组(P<0.05);两组间术后恶心呕吐发生率的差异无统计学意义(P>0.05)。结论0.5 mg/kg酮咯酸氨丁三醇可安全、有效地预防OSAS患儿全身麻醉苏醒期躁动的发生。Objective To investigate the effect of ketorolac tromethamine on emergence agitation during recovery from general anesthesia in children with obstructive sleep apnea syndrome （OSAS）. Methods Eighty children with OSAS who underwent elective tonsillectomy and adenoidectomy were randomly divided into treatment group and control group （n = 40）. Sevoflurane （volume fraction of 0.08） was inhaled with 02 （volume fraction of 1, flow of 8- 10 L） in all the children. The peripheral veins were opened after the disappearance of consciousness. Anesthesia was induced by propofol 1.5 - 2.0 mg/kg in combination with dexamethasone 0. 1 mg/kg, atropine 0.01 mg/kg, fentanil 2 lug/kg and rocuronium bromide 0. 6 mg/kg. Then appropriate endotracheal tube was inserted. Anesthesia was maintained with propofol （2- 4 mg· kg^-1· h^-1） and remifentanil （0. 05- 0.25 μg·kg^-1·min^-1） by intravenous administration and sevoflurane inhalation （volume fraction of 0. 01 - 0. 025）. Ketorolac tromethamine （0.5 mg/kg, 〈15 mg） was intravenously injected in the treatment group during postanesthesia care unit （PACU）, while normal saline was given in the control group. The time of operation, respiratory recovery, eye opening and extubation and the complications such as respiratory depression, postoperative nausea and vomiting were recorded. The agitation was assessed using the pediatric anesthesia emergence delirium （PAED） scale. Postoperative pain was evaluated using the face pain scale （FPS）. ResultsThe FPS scores, PAED scores and incidences of agitation and adverse events related to respiration in the treatment group were significantly lower than those in the control group （all P^0.05）. The patients in whom propofol and tramadol were essentially given in the treatment group were significantly less than the control group （both P〈0.05）. There was no significant difference in the incidence of postoperative nausea or vomiting between two groups （P〉0.05〉. Conclusion Ketorolac tromethamine i

关 键 词：酮咯酸氨丁三醇 麻醉恢复期 躁动 儿童 

分 类 号：R726.1[医药卫生—儿科]