芬太尼复合地塞米松对扁桃体及腺样体射频消融术患儿苏醒期躁动的影响  

The effect of combination of fentanyl and dexamethasone on preventing emergence agitation in children undergoing adenotonsillectomy

作　　者：章艳君[1] 刘金柱[1] 张文静[1] 赵娟[1] 

机构地区：[1]天津市儿童医院麻醉科,300074

出　　处：《临床麻醉学杂志》2015年第10期962-965,共4页Journal of Clinical Anesthesiology

摘　　要：目的评价芬太尼复合地塞米松对扁桃体及腺样体射频消融术患儿苏醒期躁动的影响。方法择期行扁桃体及腺样体射频消融术的阻塞性呼吸睡眠综合征患儿120例,男79例,女41例,年龄3~6岁,ASAⅠ级,采用随机数字表法,将患儿分为四组：芬太尼组（F组）、地塞米松组（D组）、芬太尼＋地塞米松组（FD组）和对照组（C组）。吸入8%七氟醚,静注阿曲库铵0.5mg/kg、瑞芬太尼1μg/kg和咪达唑仑0.1 mg/kg行麻醉诱导;术中吸入2%~3%七氟醚。手术结束前10min,四组分别静脉注射芬太尼1μg/kg、地塞米松0.2mg/kg、芬太尼1μg/kg加地塞米松0.2mg/kg和等容量生理盐水,术毕停止吸入七氟醚。记录拔管时间、麻醉后恢复室（PACU）停留时间;PACU期间记录患儿躁动发生情况,采用患儿麻醉苏醒期躁动量化评分表（PAED）评价躁动程度。记录患儿入PACU即刻（T0）、15min（T1）、30min（T2）时FLACC评分和Ramsay镇静评分。术后24h随访记录患儿恶心呕吐、呼吸抑制等不良反应的发生情况。结果 T0~T2时F组、D组和FD组FLACC评分明显低于C组,且F组和D组FLACC评分明显高于FD组（P〈0.05）;T0、T1时F组、D组和FD组Ramsay评分明显高于C组（P〈0.05）。四组拔管时间及PACU停留时间差异无统计学意义。F组、D组和FD组躁动发生率和PAED评分明显低于C组,FD组躁动发生率和PAED评分明显低于F组和D组（P〈0.05）。D组和FD组恶心呕吐发生率明显低于F组（P〈0.05）。结论芬太尼、地塞米松和芬太尼复合地塞米松都可以有效减少扁桃体及腺样体射频消融术患儿苏醒期躁动的发生;但芬太尼复合地塞米松的患儿躁动程度明显减轻,且不良反应少。Objective The purpose of this study was to investigate the efficacy of fentanyl plus dexamethasone on post-operative emergence agitation in children undergoing Adenotonsillectomy.Methods One hundred and twenty patients,male 79 cases,female 41 cases,aged 3-6years,ASA Ⅰgrade,were randomized into four groups（n=30each）：the fentanyl group（group F）,the dexamethasone group（group D）,the fentanyl plus dexamethasone group（group FD）and the control group（group C）.Anaesthesia was induced by facemask with 8% sevoflurane.After loss of consciousness,atracurium,remifentanil and midazolam were administered.Anaesthesia was maintained with sevoflurane.Fentanyl 1μg/kg,dexamethasone 0.2mg/kg,fentanyl 1μg/kg plus dexamethasone 0.2mg/kg or the same volume saline were administered intravenous respectively 10 minutes before the end of surgery.The incidence of EA was assessed with five point scale and the severity of EA was assessed with pediatric anesthesia emergence delirium（PAED）scale.The time to extubation,time to discharge from the postanesthesia care unit（PACU）,recorded FLACC and Ramsay scores of arriving PACU immediately（T0）,15min（T1）,30 min（T2）,postoperative nausea and vomiting were assessed.Results Compared with group C,the incidence of emergence agitation and PAED scales were lower in groups F,D and FD.PAED scale was lower in group FD than in groups F and D（P〈0.05）.Compared with group C,FLACC scores were lower in the groups F,D and FD at T0-T2.FLACC scores were lower in the group FD than in groups F and D.Compared with group C,Ramsay score was higher in the group F,D and FD at T0（immediately arrived in PACU）and T1（15minutes after arrived in PACU）（P〈0.05）.Compared with group F,the incidence of nausea or vomiting was significantly less in groups D and FD（P〈0.05）.Time to tracheal extubation and time to discharge from the PACU were similar for the 4groups.Conclusion Fentanyl,dexamethasone and combination of them are superior to placebo for prevention the agitatio

关 键 词：苏醒期躁动 芬太尼 地塞米松 患儿 

分 类 号：R726.1[医药卫生—儿科]