术前单剂量芬太尼对小儿日间扁桃体腺样体切除术后镇静和苏醒期躁动的影响  

Effects of preoperative single-dose of fentanyl on sedation and agitation during recovery after pediatric adenotonsillectomy day surgery

作　　者：章钰 黄超群[1] 白玥 励建琳 周盈丰 袁开明[1] 李军[1] ZHANG Yu;HUANG Chaoqun;BAI Yue;LI Jianlin;ZHOU Yingfeng;YUAN Kaiming;LI Jun(Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital&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11期1272-1277,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：重大新药创制国家科技重大专项(2020ZX09201002)。

摘　　要：目的:观察麻醉诱导时单次推注芬太尼对小儿日间扁桃体腺样体切除术后镇静及苏醒期躁动(emergence agitation,EA)的影响。方法:选取2022年1-3月在温州医科大学附属第二医院择期行扁桃体腺样体切除术患儿157例,美国麻醉医师协会(ASA)I或II级,年龄3~10岁。采用随机数字表法将患儿分为两组:瑞芬太尼复合芬太尼组(RF组,78例)和瑞芬太尼组(R组,79例),RF组诱导时单次推注芬太尼1μg/kg+瑞芬太尼2.5μg/kg,R组静注等体积生理盐水+瑞芬太尼2.5μg/kg;两组均在丙泊酚诱导后行气管插管并采用七氟烷联合瑞芬太尼全身麻醉。记录患儿在麻醉恢复室(post-anesthesia care unit,PACU)EA的发生率及严重程度、Ramsay镇静评分及FLACC疼痛评分,记录拔管时间、苏醒时间、PACU停留时间、出院时间。结果:与R组相比,RF组患儿EA发生率明显下降(38.0%vs.18.0%,P=0.005),苏醒期最大小儿麻醉苏醒期躁动(pediatric anesthesia emergence delirium,PAED)评分明显降低(7.7±3.3 vs.8.9±3.4,P=0.027),在PACU 15 min及出PACU时Ramsay镇静评分显著升高(4.4±1.1 vs.3.8±1.4,P=0.01;2.0±0.3 vs.1.8±0.4,P=0.03);而两组患儿拔管时间、苏醒时间、PACU停留时间、出院时间、疼痛评分(出PACU时和术后2 h)等指标差异均无统计学意义(P>0.05)。结论:麻醉诱导单次推注芬太尼1μg/kg能增加小儿扁桃体腺样体切除术后PACU的镇静程度并降低EA发生率。AIM:To observe the effects of single-dose of fentanyl on sedation and agitation during recovery after pediatric adenotonsillectomy day surgery during anesthesia induction.METHODS:A total of 157 children undergoing elective adenotonsillectomy,with ASA physical status I or II,aged 3-10 years were selected during January and March in 2022 in the Second Affiliated Hospital of Wenzhou Medical University.The children were divided into two groups according to random number table method:remifentanil combined with fentanyl group(group RF,n=78)and remifentanil group(group R,n=79).Children in group RF received a single-dose injection of 1μg/kg of fentanyl and 2.5μg/kg of remifentanil during induction,children in group R received an equal volume of normal saline and 2.5μg/kg of remifentanil injection.Children in both groups were intubated after propofol induction and anesthetized with combination of sevoflurane-remifentanil.The incidence and severity of emergence agitation(EA),Ramsay sedation score and FLACC pain score in post-anesthesia care unit(PACU),extubation time,recovery time,PACU stay time,discharge time were recorded.RESULTS:Compared with group R,the incidence of EA was significantly lower(38.0%vs.18.0%,P=0.005),the maximum PAED score during recovery was significantly lower(7.7±3.3 vs.8.9±3.4,P=0.027),and the Ramsay sedation score was significantly higher at 15 min after admission of PACU(4.4±1.1 vs.3.8±1.4,P=0.01),as well as discharge of PACU(2.0±0.3 vs.1.8±0.4,P=0.03)in RF group.There was no significant difference in extubation time,recovery time,PACU stay time,discharge time,pain score(discharge of PACU and 2 h after operation)between two groups(P>0.05).CONCLUSION:A single-dose injection of fentanyl(1μg/kg)during anesthesia induction can increase the degree of sedation and reduce the incidence of EA in PACU after pediatric daytime adenotonsillectomy.

关 键 词：镇静 苏醒期躁动 芬太尼 扁桃体腺样体切除术 小儿 

分 类 号：R614[医药卫生—麻醉学]