阿芬太尼对扁桃体腺样体切除患儿气管插管效果的随机双盲研究  

Effects of alfentanil on tracheal intubation during tonsillectomy in children: A randomized double-blind study

作　　者：李佳佳[1] 陈蒙蒙 王睿娴 黄梦朦 李军[1] 上官王宁[1] LI Jiajia;CHEN Mengmeng;WANG Ruixian;HUANG Mengmeng;LI Jun;SHANGGUAN Wangning(Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou 325027,Zhejiang,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院麻醉与围术期医学科,浙江温州325027

出　　处：《中国临床药理学与治疗学》2022年第2期184-189,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：重大新药创制科技重大专项(2020ZX09201002)。

摘　　要：目的:比较不同剂量阿芬太尼诱导对行扁桃体腺样体切除术患儿气管插管条件、血流动力学参数及苏醒质量的影响。方法:选取90例择期行扁桃体腺样体切除术的患儿,随机分为3组,每组30例,分别给予阿芬太尼20μg/kg(A20组)、40μg/kg(A40组)和60μg/kg(A60组)进行麻醉诱导,余麻醉诱导和维持方案一致。评估3组患儿的Helbo-Hansen评分,记录麻醉诱导前(T0)、气管插管前(T1)、气管插管即刻(T2)、插管后1 min(T3)的平均动脉压(MAP)、心率(HR)以及自主呼吸恢复时间、睁眼时间、拔管时间、入恢复室后的躁动评分和药物不良反应。结果:与A20组比较,A40、A60组患儿Helbo-Hansen整体评分和咳嗽得分较低(P<0.05)。与T0比较,A40和A60组患儿在T1~T3时点MAP降低,A20组患儿T2、T3时点HR增快,A40组患儿T1时点HR减慢,A60组患儿T1~T3时点HR减慢(P<0.05);与A20组比较,A40组患儿T1~T3时点MAP较低,T2、T3时点HR较慢,A60组患儿T1~T3时点MAP较低、HR较慢(P<0.05)。A60组患儿自主呼吸恢复时间和拔管时间延长(P<0.05)。结论:扁桃体腺样体切除术患儿麻醉诱导期给予阿芬太尼40μg/kg或60μg/kg联合丙泊酚3 mg/kg、罗库溴铵0.3 mg/kg均可使患儿获得满意的气管插管条件,而前者麻醉诱导期间生命体征更平稳,可实现术后快速拔管。AIM:To compare the effects of different doses of alfentanil on tracheal intubation conditions,hemodynamic parameters and recovery quality in children undergoing tonsillectomy.METHODS:Ninety children undergoing tonsillectomy were randomly divided into 3 groups,and received alfentanil 20μg/kg(A20 group),40μg/kg(A40 group)and 60μg/kg(A60 group)for anesthesiainduction respectively,30 cases in each group.The remaining anesthesia induction and maintenance protocols were the same.The Helbo-Hansen scores of the three groups were evaluated,and the MAP and HR before anesthesia induction(T0),before tracheal intubation(T1),immediately after tracheal intubation(T2),and 1 min after intubation(T3)as well as the recovery time of spontaneous breathing,eye opening time,extubated time,agitation score in PACU,and adverse drug reactions were recorded.RESULTS:Compared with A20 group,the total values of Helbo-Hansen score and cough scores in group A40 and A60 were lower(P<0.05).Compared with T0,the MAP at T1-T3 were decreased in group A40 and A60,and HR increased at T2 and T3 in group A20 while HR slowed down at T1 in group A40,and at T1-T3 in group A60(P<0.05).Compared with A20 group,children in group A40 had lower MAP and slower HR at T1-T3,while those in group A60 had lower MAP and slower HR at T1-T3(P<0.05).The recovery time of spontaneous breathe and extubated time were prolonged in group A60(P<0.05).CONCLUSION:During the anesthesia induction period of tonsillectomy in children,both afentanil 40μg/kg or 60μg/kg combined with propofol 3 mg/kg and rocuronium 0.3 mg/kg can provide satisfactory intubation condition,while the vital signs are more stable during anesthesia induction in afentanil 40μg/kg group and rapid extubation after operation can be achieved.

关 键 词：阿芬太尼 扁桃体腺样体切除术 气管插管反应 儿童 

分 类 号：R971[医药卫生—药品]