舒更葡糖钠和新斯的明对小儿扁桃体切除术后躁动的影响评估  

Effect of Sugammadex and Neostigmine on Agitation After Tonsillectomy in Children

作　　者：徐丽莉[1] 侯明勇[1] 欧珊[1] XU Lili;HOU Mingyong;OU Shan(Department of Anesthesiology,First People’s Hospital of Chengdu,Chengdu 610095,China)

机构地区：[1]成都市第一人民医院麻醉科,四川成都610095

出　　处：《河南医学研究》2021年第32期5971-5976,共6页Henan Medical Research

基　　金：四川省卫生健康委基金研究项目(18PJ178)。

摘　　要：目的评估舒更葡糖钠和新斯的明对扁桃体切除术患儿术后躁动的影响。方法选择2018年6月至2019年10月在成都市第一人民医院择期行等离子扁桃体切除术的儿童患者90例,年龄3~10岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,按照计算机产生的随机数字将患者分为3组,每组30人:舒更葡糖钠组(S组)、新斯的明组(N组)和安慰剂组(P组);所有患儿均接受全身麻醉,术中使用罗库溴铵维持肌松,手术结束后当4个成串刺激(TOF)恢复到T_(2)出现时,静脉注射拮抗药物,给予S组舒更葡糖钠2 mg·kg^(-1),给予N组新斯的明0.05 mg·kg^(-1)和阿托品0.02 mg·kg^(-1),给予P组生理盐水。记录患儿肌力恢复时间,拔管时间和复苏时间。采用儿童麻醉苏醒期躁动量化评分表(PAED)评估患儿术后躁动,采用儿童疼痛行为量表(FLACC)对患儿进行疼痛评估,记录术后30 min内患儿的疼痛和躁动评分和各组严重躁动发生率,记录手术结束(T_(0)),拮抗后1 min(T_(1))、拮抗后5 min(T_(2))、拮抗后10 min(T_(3))、拮抗后20 min(T_(4))时的心率和平均动脉压变化。记录术后24 h内患儿发生喉痉挛、低氧血症等不良反应。结果 S组患儿肌力恢复时间、拔管时间均短于N组、P组(P<0.05);各组间术后疼痛评分对比差异无统计学意义(P>0.05),N组术后躁动评分高于P组和S组(P<0.001),N组术后躁动发生率高于S组(P<0.05)。N组呕吐发生率高于P组和S组(P<0.05);各组其他不良反应发生率对比,差异无统计学意义(P>0.05)。结论舒更葡糖钠可缩短扁桃体切除术患儿术后肌松恢复时间和拔管时间,对患儿术后躁动无明显影响,新斯的明和阿托品可增加扁桃体切除术患儿术后躁动评分和发生率。Objective To assess the effect of sugammadex and neostigmine on agitation after tonsillectomy in children.Methods Ninety children who underwent tonsillectomy in First People’s Hospital of Chengdu from June 2018 to October 2019 were selected.The children were 3-10 years old,and American Society of Anesthesiologists(ASA) grades Ⅰ to Ⅱ.The children were allocated to three groups:sugammadex group(group S),neostigmine group(group N) and placebo group(group P) according to random numbers generated by the computer,with 30 patients in each group.All patients received general anesthesia and rocuronium was used to maintain muscle relaxation during surgery.At the end of the surgery,antagonistic drugs were administered when train of four stimulation(TOF) returned to T_(2).Group S was given sugammadex 2 mg·kg^(-1),group N was given neostigmine 0.05 mg·kg^(-1) and atropine 0.02 mg·kg^(-1),and group P was given normal saline.Muscle strength recovery time,extubation time and resuscitation time were recorded.The pediatric anesthesia emergence delirium scale(PAED) was used to evaluate postoperative agitation.Pain was assessed with the face,leg,activity,cry,consolablity observational tool(FLACC).Postoperative pain and agitation scores were recorded within 30 minutes with the incidence of severe agitation in each group.Changes in heart rate and mean arterial pressure were recorded at the end of surgery(T_(0)),1 minute after antagonism(T_(1)),5 minutes after antagonism(T_(2)),10 minutes after antagonism(T_(3)),and 20 minutes(T_(4)) after antagonism.Adverse reactions such as laryngospasm and hypoxemia were recorded in the children within 24 h after surgery.Results Muscle recovery time and extubation time in group S were shorter than in group N and P(P<0.05).There was no significant difference in postoperative pain scores among groups(P>0.05).Postoperative agitation scores were higher in the group N than in the group P and S(P<0.001).The incidence of postoperative agitation in group N was higher than that in group S(P<0.05).Th

关 键 词：舒更葡糖钠 新斯的明 儿童 扁桃体手术 术后躁动 

分 类 号：R614.4[医药卫生—麻醉学]