羟考酮与芬太尼用于七氟烷全身麻醉小儿预防术后躁动的研究  

Study on the effect of oxycodone and fentanyl on emergent agitation in children anesthetized by sevoflurane

作　　者：杨文婧[1] 赵萌萌 陈晨[1] 崔旭[1] YANG Wen-jing;ZHAO Meng-meng;CHEN Chen(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,北京100730

出　　处：《临床和实验医学杂志》2019年第7期778-782,共5页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金资助项目(编号:81301065);北京市优秀人才培养计划资助项目(编号:2013D003034000031)

摘　　要：目的对比羟考酮与芬太尼用于七氟烷全身麻醉行眼科手术小儿预防术后躁动的效果。方法前瞻性选择2018年9～12月在首都医科大学附属北京同仁医院择期行斜视矫正手术的患儿80例,年龄3～7岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级。采用随机数字表法将患儿分为两组:羟考酮组(O组)及芬太尼组(F组)。采用8%七氟醚与4 L/min氧气吸入诱导,待麻醉深度合适后置入喉罩,术中保留自主呼吸单纯七氟烷吸入维持,手术结束前15 min,O组静脉缓慢滴注盐酸羟考酮0.075 mg/kg,F组患儿静脉缓慢滴注芬太尼1μg/kg,并给予同步间歇指令通气(SIMV)。术毕停用七氟烷,拔除喉罩送入麻醉恢复室。记录患儿年龄、性别构成比、体重、手术时间、七氟醚吸入时间、意识恢复时间、恢复室停留时间,并定时评估术后躁动评分(PAED)、镇痛评分(FLACC),记录低氧血症、头晕、嗜睡、恶心呕吐及排便障碍等不良反应发生率。结果 O组与F组患儿年龄、性别、体重、手术时间及七氟醚吸入时间比较差异无统计学意义。O组患儿意识恢复时间及恢复室停留时间分别为(15.9±3.8)、(27.9±5.1) min,与F组[(16.1±4.2)、(25.1±4.4) min]比较,差异无统计学意义(P> 0.05)。O组患儿术后PAED评分为4.9(3.8)分,与F组6.0(3.4)分比较,差异无统计学意义(P> 0.05); O组患儿术后躁动发生率为10.0%(4/40),与F组术后躁动发生率15.0%(6/40)比较,差异无统计学意义(P> 0.05)。O组患儿FLACC评分为1.0[2.1],与F组3.6[2.0]比较差异具有统计学意义(P=0.001); O组术后疼痛发生率为5.0%(2/40),与F组20.0%(8/40)比较,差异具有统计学意义(P=0.043)。两组患儿各种不良反应的发生率比较,差异无统计学意义(P>0.05)。结论静脉应用羟考酮与芬太尼同样可安全应用于七氟烷全身麻醉行眼科手术小儿,术后躁动发生率低;与芬太尼相比,静脉应用羟考酮的患儿术后疼痛评分更低,舒适度更高。Objective To compare the effect of oxycodone hydrochloride and fentanyl on prevention of emergent agitation in children undergoing ophthalmologic surgery under sevoflurane general anesthesia.Methods A total of 80 pediatric patients aged 3~7 undergoing elective strabismus surgery in this hospital during September to December in 2018.According to the classification of American Society of Anesthesiologists(ASA),they belong to classⅠ~Ⅱ,and they were selected prospectively.They were divided into two groups:Oxycodone group(group O)and Fentanyl group(group F)by random number table method.Inhalation induction was performed by 8%sevoflurane and 4 L/min oxygen inhalation,and the laryngeal mask was inserted after appropriate depth of anesthesia.During the operation,sevoflurane inhalation was retained for spontaneous breathing.Fifteen minutes before the end of the operation,Oxycodone hydrochloride(0.075 mg/kg)was given to patients of group O,and Fentanyl(1μg/kg)was given to patients of group F respectively,and synchronous intermittent command ventilation(SIMV)was given if needed.After the operation,these children were sent to the post anesthesia care unit(PACU).Two nurses in PACU recorded consciousness recovery time and PACU stay time.They also assessed pediatric anesthesia emergence delirium PAED)scores,face legs activity cry consolability behavioral pain assessment tool(FLACC)scores.The incidence of adverse reactions such as hypoxemia,dizziness,drowsiness,nausea and vomiting were recorded.Results There was no significant difference in age,gender,weight,operating time and sevoflurane inhalation time between group O and group F.There was no significant difference in consciousness recovery time and PACU stay time between group F(16.1±4.2)min,(25.1±4.4)min and group O(15.9±3.8)min,(27.9±5.1)min,respectively(P>0.05).The postoperative PAED scores of pediareic patients in group O were 4.9(3.8),which was not statistically significant(P>0.05)in comparison with group F 6.0(3.4).The incidence of postoperative restlessness wa

关 键 词：小儿 全身麻醉 七氟烷 术后躁动 羟考酮 芬太尼 

分 类 号：R726.1[医药卫生—儿科]