芬太尼复合地塞米松对扁桃体及腺样体射频消融术患儿苏醒期躁动的影响

发布时间：2018-03-14 13:39

本文选题：苏醒期躁动　切入点：芬太尼　出处：《临床麻醉学杂志》2015年10期 　论文类型：期刊论文

【摘要】：目的评价芬太尼复合地塞米松对扁桃体及腺样体射频消融术患儿苏醒期躁动的影响。方法择期行扁桃体及腺样体射频消融术的阻塞性呼吸睡眠综合征患儿120例,男79例,女41例,年龄3~6岁,ASAⅠ级,采用随机数字表法,将患儿分为四组:芬太尼组(F组)、地塞米松组(D组)、芬太尼+地塞米松组(FD组)和对照组(C组)。吸入8%七氟醚,静注阿曲库铵0.5mg/kg、瑞芬太尼1μg/kg和咪达唑仑0.1 mg/kg行麻醉诱导;术中吸入2%~3%七氟醚。手术结束前10min,四组分别静脉注射芬太尼1μg/kg、地塞米松0.2mg/kg、芬太尼1μg/kg加地塞米松0.2mg/kg和等容量生理盐水,术毕停止吸入七氟醚。记录拔管时间、麻醉后恢复室(PACU)停留时间;PACU期间记录患儿躁动发生情况,采用患儿麻醉苏醒期躁动量化评分表(PAED)评价躁动程度。记录患儿入PACU即刻(T0)、15min(T1)、30min(T2)时FLACC评分和Ramsay镇静评分。术后24h随访记录患儿恶心呕吐、呼吸抑制等不良反应的发生情况。结果 T0~T2时F组、D组和FD组FLACC评分明显低于C组,且F组和D组FLACC评分明显高于FD组(P0.05);T0、T1时F组、D组和FD组Ramsay评分明显高于C组(P0.05)。四组拔管时间及PACU停留时间差异无统计学意义。F组、D组和FD组躁动发生率和PAED评分明显低于C组,FD组躁动发生率和PAED评分明显低于F组和D组(P0.05)。D组和FD组恶心呕吐发生率明显低于F组(P0.05)。结论芬太尼、地塞米松和芬太尼复合地塞米松都可以有效减少扁桃体及腺样体射频消融术患儿苏醒期躁动的发生;但芬太尼复合地塞米松的患儿躁动程度明显减轻,且不良反应少。
[Abstract]:Objective to evaluate the effect of fentanyl combined with dexamethasone on restlessness in children with tonsil and adenoid radiofrequency ablation. 41 female patients, aged from 3 to 6 years old, were randomly divided into four groups: fentanyl group (group F), dexamethasone group (group D), fentanyl dexamethasone group (group FD) and control group (group C). 8% sevoflurane was inhaled. Intravenous administration of atracurium (0.5 mg / kg), remifentanil (1 渭 g / kg) and midazolam (0.1 mg/kg) was used to induce anaesthesia. 10 minutes before the operation, fentanyl 1 渭 g / kg, dexamethasone 0.2 mg / kg, fentanyl 1 渭 g / kg plus dexamethasone 0.2 mg / kg and isobaric saline were inhaled during the operation. Stop inhaling sevoflurane at the end of the operation. Record the extubation time, the PACUU residence time after anesthesia and the restlessness during PACU. The restlessness degree was evaluated by the restlessness quantitative scale (Padem) during anaesthesia recovery. The FLACC score and the Ramsay sedative score were recorded at the time of PACU immediate T0 / T0 / T1 / 30 min / T2. The nausea and vomiting were recorded at 24 hours after operation, and nausea and vomiting were recorded at 24 hours after operation. Results the FLACC scores of group F and group FD were significantly lower than those of group C at T _ 0 T _ 2. The FLACC score of group F and group D was significantly higher than that of group F and group D at T 0 / T 1. The Ramsay score of group F and group D was significantly higher than that of group C (P 0.05). There was no significant difference in extubation time and PACU residence time among four groups. There was no significant difference in restlessness and PAED score between group F and group D and FD. The incidence of restlessness and PAED score in group C were significantly lower than those in group F, group D and group D. the incidence of nausea and vomiting in group D was significantly lower than that in group F (P 0.05). Both dexamethasone and fentanyl combined with dexamethasone can effectively reduce restlessness in children with tonsil and adenoid radiofrequency ablation, but fentanyl combined with dexamethasone can significantly reduce the restlessness and decrease adverse reactions.
【作者单位】：天津市儿童医院麻醉科;
【分类号】：R726.1

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