不同剂量的阿芬太尼复合右美托咪定在小儿腺样体切除术中的应用效果评价  

The effects of different doses of alfentanil combined with dexmedetomidine during adenoidectomy in children with general anesthesia

作　　者：邱金 王媛媛 QIU Jin;WANG Yuan-yuan(Department of Anesthesiology,The Forth Affiliated Hospital to China Medical University,Shenyang 110032,China)

机构地区：[1]中国医科大学附属第四医院麻醉科,沈阳110032

出　　处：《中国新药杂志》2022年第22期2257-2261,共5页Chinese Journal of New Drugs

基　　金：辽宁省自然科学基金:TNF超家族成员对肠道肿瘤免疫环境的调控机制研究(2021-MS-163)。

摘　　要：目的:观察不同剂量的阿芬太尼复合右美托咪定对小儿全麻术后躁动的影响。方法:择期全麻下行腺样体切除术患儿90例,随机分为3组,每组30例。麻醉诱导前0.5μg·kg^(-1)右美托咪定10 min内静脉泵注;麻醉诱导:A10组阿芬太尼10μg·kg^(-1)静注;A20组阿芬太尼20μg·kg^(-1)静注;A30组阿芬太尼30μg·kg^(-1)静注,术中七氟烷吸入麻醉维持。主要结局指标为患儿术后躁动发生情况:拔管即刻(E0),拔管后5 min(E5),拔管后10 min(E10)术后苏醒期躁动量表(paediatric anesthesia emergence delirium, PAED)评分、Aono’s评分、术后躁动发生率。次要结局指标:患儿自主呼吸恢复时间、拔管时间、PACU停留时间,记录患儿疼痛评估FLACC量表评分、追加镇痛药情况、不良事件发生情况。结果:与A10组相比,A20组和A30组E0,E5,E10时间点的PAED评分,E0和E5时间点的Aono’s评分,术后躁动发生率均显著降低(P<0.05)。与A10和A20组相比,A30组术后自主呼吸恢复时间、拔管时间、PACU停留时间显著延长(P<0.05);与A10组相比,A20组和A30组FLACC评分显著降低,追加阿芬太尼的患儿例数及呛咳发生率均显著降低(P<0.05);与A10和A20组相比,A30组的嗜睡发生率显著增高(P<0.05)。结论:阿芬太尼20μg·kg^(-1)复合右美托咪定可用于全麻小儿腺样体切除术中,可有效降低术后躁动发生,安全性更高,并发症更少。Objective: To observe the effectiveness of dexmedetomidine combined with different doses of alfentanil in preventing emergence agitation in children under general anesthesia. Methods: Ninety children(ASA I or II, 3~7 years old) undergoing adenoidectomy with general anesthesia were randomly assigned into three groups, 30 patients in each group. All of the three groups were given 0.5 μg·kg^(-1)dexmedetomidine infusion within 10 minutes before the induction of anesthesia. Group A10, A20 and A30 were given alfentanil 10, 20, and 30 μg·kg^(-1), respectively. Sevoflurane was used for anesthesia maintenance. The incidence of agitation, time of respiratory restoration, time of extubation, and time of stay in PACU were recorded. The incidence of EA was assessed with the Aono’s scale, and the severity of EA was evaluated using the Pediatric Anesthesia Emergence Delirium(PAED) scale. The Aono’s scale and PAED scale at the time of tracheal extubation(E0), 5 min after tracheal extubation(E5) and 10 min after tracheal extubation(E10) were recorded too. The FLACC scale, additional analgesics and adverse reactions were also recorded. Results: Compared with group A10, the incidence of agitation, the Aono’s scale, the PAED scale FLACC scale of early postoperative analgesia, the number of additional analgesics and the incidence of cough after extubation were lower in group A20 and group A30(P<0.05). There was no significant difference between group A20 and group A30(P>0.05). Compared with group A10 and group A20, the recovery time of spontaneous breathing, extubation time and PACU stay time were longer(P<0.05), and the incidence of drowsiness of group A30 increased significantly(P<0.05). Conclusion: In children, alfentanil 20 μg·kg^(-1)combined with dexmedetomidine can effectively reduce agitation and improve safety during adenoidectomy in children.

关 键 词：阿芬太尼 右美托咪定 腺样体切除术 术后躁动 小儿 

分 类 号：R969.4[医药卫生—药理学]