舒芬太尼复合七氟烷麻醉在小儿扁桃体或联合腺样体切除术中的应用

发布时间：2018-01-29 10:09

本文关键词： 舒芬太尼七氟烷儿童扁桃体切除术腺样体切除术　出处：《中国新药与临床杂志》2015年01期 　论文类型：期刊论文

【摘要】：目的观察舒芬太尼复合七氟烷麻醉用于小儿扁桃体或联合腺样体切除术的麻醉效果和对术后躁动的影响。方法择期行扁桃体或联合腺样体切除术的患儿40例,随机分为两组,每组20例。两组均以七氟烷、阿曲库铵麻醉诱导,试验组加用舒芬太尼0.2μg·kg-1静脉注射,对照组给予氯化钠注射液。诱导插管后,术中均吸入七氟烷维持麻醉,术毕待患儿清醒后拔除气管导管。记录诱导前(T0)、气管插管时(T1)、术中剥离扁桃体或联合腺样体时(T2)、拔管时(T3)、拔管后5 min(T4)患儿的心率(HR)、平均动脉压(MAP),记录手术时间、清醒拔管时间,拔管后5 min Ramsay镇静评分,及术后不良反应及躁动发生情况。结果试验组T3时MAP、HR水平高于T0时(P0.05),其余各时点与T0时无显著差异(P0.05)。对照组T1~T4时MAP、HR水平均高于T0时,且高于试验组,差异均有显著意义(P0.05)。T4时试验组Ramsay镇静评分高于对照组(P0.05),两组清醒拔管时间比较无显著差异(P0.05),均无严重不良反应发生,试验组躁动发生率低于对照组(5%vs.40%,P0.05)。结论舒芬太尼复合七氟烷麻醉可使扁桃体或联合腺样体切除术患儿围术期血流动力学更平稳,并可有效预防术后躁动的发生,且不影响苏醒时间。
[Abstract]:Objective to observe the anesthetic effect of sufentanil combined with sevoflurane on tonsillectomy or combined adenoidectomy in children and its effect on postoperative restlessness. Methods Forty children with selective tonsillectomy or combined adenoidectomy were studied. Two groups were randomly divided into two groups, 20 cases in each group. Both groups were induced by sevoflurane and atracurium anesthesia. The experimental group was given sufentanil 0.2 渭 g 路kg-1 intravenously. The control group was given sodium chloride injection. After induction and intubation, sevoflurane was inhaled to maintain anesthesia during the operation. The tracheal catheter was removed after the children were awake after operation. The heart rate of the children with tonsil or adenoid was removed during operation, and the heart rate was HRG when the tonsil was removed or the adenoid was removed, and the operation time was recorded at 5 min after extubation. The mean arterial pressure was MAPP, and the operation time was recorded. Conscious extubation time, sedation score 5 min after extubation, postoperative adverse reactions and restlessness. Results MAP at T3 in the test group. The level of HR was higher than that of T0, but there was no significant difference between the other time points and T0. In the control group, the level of MAPHR at T1 and T4 was higher than that at T0 and higher than that in the test group. The Ramsay sedation score of the test group was higher than that of the control group (P0.05), but there was no significant difference between the two groups in the time of extubation (P0.05). There was no serious adverse reaction. The incidence of restlessness in the test group was lower than that in the control group (5v. 40%). Conclusion Sufentanil combined with sevoflurane anesthesia can make hemodynamics of children with tonsillectomy or combined adenoidectomy more stable and can effectively prevent postoperative restlessness. And does not affect the recovery time.
【作者单位】：南京鼓楼医院集团宿迁市人民医院麻醉科;
【分类号】：R726.1
【正文快照】： 扁桃体和腺样体切除术是小儿常见的手术,由于口腔内操作手术时间短、刺激性强,术后可有残余出血,易致呼吸道阻塞,因此需起效快、术后苏醒快且彻底、躁动发生率低的麻醉方式,以避免拔管后喉痉挛及误吸等并发症[1]。七氟烷(sevoflurane)具有血气分配系数低、诱导快、刺激小、苏

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