酮咯酸氨丁三醇预防阻塞性睡眠呼吸暂停综合征患儿全身麻醉苏醒期躁动的效果

发布时间：2018-03-09 19:38

本文选题：酮咯酸氨丁三醇　切入点：麻醉恢复期　出处：《上海医学》2015年08期 　论文类型：期刊论文

【摘要】：目的评价酮咯酸氨丁三醇预防阻塞性睡眠呼吸暂停综合征(OSAS)患儿全身麻醉苏醒期躁动的效果。方法择期行扁桃体和腺样体切除术的OSAS患儿80例,分入治疗组和对照组,每组40例。所有患儿均采用体积分数为0.08的七氟烷加体积分数为1的氧气,流量8~10L诱导,待患儿意识消失后开放外周静脉。麻醉诱导给予地塞米松0.1mg/kg、阿托品0.01mg/kg、丙泊酚1.5~2.0mg/kg、罗库溴铵0.6mg/kg、芬太尼2μg/kg,达到气管插管要求后插入合适的气管导管。术中静脉注射丙泊酚2~4mg·kg-1·h-1、瑞芬太尼0.05~0.25μg·kg-1·min-1,并吸入体积分数为0.01~0.025的七氟烷维持麻醉。术毕带气管导管入麻醉后恢复室,治疗组予静脉注射酮咯酸氨丁三醇0.5mg/kg,总量15mg,对照组给予等量0.9%氯化钠溶液。记录患儿的手术时间、自主呼吸恢复时间(手术结束至自主呼吸恢复时间)、呼名睁眼时间、拔除气管导管时间、拔除气管导管后呼吸道不良事件发生情况,以及术后疼痛、躁动和恶心呕吐的发生情况。采用患儿麻醉苏醒期躁动量化评分表(PAED)评估躁动的程度,根据面部疼痛表情量表(FPS)评估术后疼痛程度。结果治疗组术后FPS评分、躁动发生率和PEAD评分均显著低于对照组(P值均0.05),需要丙泊酚和曲马多处理的患儿比例均显著低于对照组(P值均0.05),术后呼吸道不良事件发生率显著低于对照组(P0.05);两组间术后恶心呕吐发生率的差异无统计学意义(P0.05)。结论0.5 mg/kg酮咯酸氨丁三醇可安全、有效地预防OSAS患儿全身麻醉苏醒期躁动的发生。
[Abstract]:Objective to evaluate the efficacy of ketoclorotriol in preventing restlessness during general anesthesia in children with obstructive sleep apnea syndrome (OSAS). Methods 80 patients with OSAS undergoing selective tonsillectomy and adenoidectomy were divided into treatment group and control group. 40 cases in each group were induced by volume fraction of 0.08 sevoflurane and oxygen with volume fraction of 1. The peripheral vein was opened after consciousness disappeared. Dexamethasone 0.1 mg / kg, atropine 0.01 mg / kg, propofol 1.5mg / kg, rocuronium 0.6 mg / kg, fentanyl 2 渭 g / kg were injected intravenously into the tracheal tube after they met the requirements of tracheal intubation. Phenol 2O 4 mg 路kg-1 路h-1, remifentanil 0.050.25 渭 g 路kg-1 路min-1, sevoflurane with volume fraction 0.01g 路kg-1 路min-1 were inhaled to maintain anesthesia. Tracheal catheters were inserted into the recovery chamber at the end of the operation. The treatment group received intravenous injection of ketoclorobutanol 0.5 mg / kg, total 15 mg / kg, the control group was given the same amount of sodium chloride solution 0.9%. The operation time, the time of spontaneous respiratory recovery (from the end of operation to the time of spontaneous respiratory recovery and the time of opening eyes by name) were recorded in the treatment group. The time of extubation of trachea catheter, the incidence of adverse events of respiratory tract after extubation of trachea catheter, and the occurrence of postoperative pain, restlessness, nausea and vomiting. Results the postoperative pain degree was evaluated by facial pain expression scale (FPS). Results the FPS score of the treatment group was evaluated after operation. The incidence of restlessness and PEAD score were significantly lower than those of the control group (P < 0.05), the proportion of children requiring propofol and tramadol treatment were significantly lower than those of the control group (P = 0.05), the incidence of postoperative adverse respiratory events was significantly lower than that of the control group (P 0.05). There was no significant difference in the incidence of nausea and vomiting between the two groups (P 0.05). Conclusion it is safe to use ketoprolol for 0.5 mg/kg. It can effectively prevent restlessness during general anesthesia recovery in children with OSAS.
【作者单位】：沈阳军区总医院麻醉科;
【分类号】：R726.1

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