七氟醚麻醉下苏醒期谵妄患儿注意网络的研究  

Attention network in children with emergence delirium under sevoflurane anesthesia

作　　者：李珺[1] 方家佳 徐光红[1] Li Jun;Fang Jiajia;Xu Guanghong(Department of Anaesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院,合肥230022

出　　处：《国际麻醉学与复苏杂志》2025年第1期26-30,共5页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(81870837)。

摘　　要：目的探讨七氟醚麻醉下苏醒期谵妄(ED)患儿围手术期注意网络效率及术后2周不良行为变化。方法七氟醚麻醉下行扁桃体/腺样体切除术的4~12岁患儿110例,根据是否发生ED,分为谵妄组(42例)和非谵妄组(68例)。两组患儿均采用6%~8%七氟醚吸入+舒芬太尼0.4μg/kg、苯磺顺阿曲库铵0.2 mg/kg、地塞米松0.1 mg/kg静脉注射进行麻醉诱导,麻醉维持均持续吸入2%~3%七氟醚,静脉输注瑞芬太尼0.1~0.5μg·kg^(−1)·min^(−1)。记录两组患儿一般资料[性别比、年龄、体重指数、术前改良耶鲁焦虑量表(mYPAS)评分、面罩接受度评分]、拔管时间、麻醉时间、手术时间、麻醉后监测治疗室(PACU)停留时间、FLACC评分(最高评分)、镇痛补救例数,记录两组患儿术前、术后1 d的注意网络效率(包括警觉、定向、执行控制3个子网络)、正确率、平均反应时间(RT),术后2周电话随访门诊手术住院后行为问卷(PHBQ⁃AS)评分,评估患儿术后不良行为变化。结果两组患儿一般资料差异无统计学意义(均P>0.05)。两组患儿拔管时间、麻醉时间、手术时间、PACU停留时间、FLACC评分(最高评分)、镇痛补救例数差异无统计学意义(均P>0.05)。与术前比较,谵妄组患儿术后1 d执行控制网络效率减弱(P<0.05);与非谵妄组比较,谵妄组患儿术后1 d执行控制网络效率较弱(P<0.05);两组患儿警觉、定向网络的效率及正确率、平均RT比较差异无统计学意义(均P>0.05)。术后2周谵妄组患儿PHBQ⁃AS评分高于非谵妄组(P<0.05);两组患儿术后2周不良行为变化(改善、变差和无变化的比例)差异无统计学意义(均P>0.05)。结论ED患儿术后1 d执行控制网络效率未恢复到基线水平,伴有术后早期(2周)PHBQ⁃AS评分偏高。Objective To investigate perioperative attention network in children with emergence delirium(ED)under sevo⁃flurane anesthesia and adverse behavioral changes within postoperative two weeks.Methods A total of 110 children,aged 4 to 12 years,who underwent tonsil/adenoidectomy under sevoflurane anesthesia were selected.According to the occurrence of ED,they were divided into two groups:a delirium group(n=42)and a non⁃delirium group(n=68).Anesthesia induction was performed in both groups using 6%−8%sevoflurane through inhalation and sufentanil at 0.4μg/kg,sulfenammonium cisatracurium at 0.2 mg/kg,and dexameth⁃asone at 0.1 mg/kg through intravenous injection,followed by maintenance of anesthesia using 2%−3%sevoflurane through inhala⁃tion,and remifentanil at 0.1−0.5μg·kg^(−1)·min^(−1) through intravenous infusion.Their general information[sex ratio,age,body mass in⁃dex,the modified Yale Preoperative Anxiety Scale(mYPAS)score before surgery,and mask acceptance score],time to extubation,an⁃esthesia duration,operation duration,the length of post⁃anesthesia care unit(PACU)stay,the Faces,Legs,Activity,Cry and Consola⁃bility(FLACC)scores(the highest scores),and the use of rescue analgesics.Their attention network efficiency(including sub⁃networks such as alerting,orienting,and executive control),correctness rates,and mean reaction time(RT)were recorded before surgery and on postoperative day 1.Furthermore,the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery(PHBQ⁃AS)scores were evaluated through telephone follow⁃up at postoperative two weeks to evaluate behavioral changes in the children.Re⁃sults There were no statistical differences in general information between the two groups(all P>0.05).No statistical differences were found in time to extubation,anesthesia duration,operation duration,the length of PACU stay,the FLACC score(the highest scores),or the use of rescue analgesics(all P>0.05).However,compared with those before surgery,the efficiency of executive control netw

关 键 词：七氟醚 苏醒期谵妄 注意网络 

分 类 号：R47[医药卫生—护理学]