地佐辛对幼儿瑞芬太尼复合七氟烷全身麻醉苏醒期质量的影响

Effect of dezocine on recovery period of general anesthesia with remifentanil and sevoflurance in children

目的 探讨不同剂量地佐辛对1-3岁幼儿瑞芬太尼复合七氟烷全身麻醉苏醒期质量的影响。方法 选取2015年7—9月于东莞东华医院择期行腹腔镜疝囊高位结扎术幼儿150例，采用随机数字表法将患者分为D1组、D2组和对照组，各50例。麻醉诱导时，D1组静脉注射地佐辛0.1 mg/kg，D2组静脉注射地佐辛0.2 mg/kg，对照组注射等容积的0.9%氯化钠注射液。麻醉维持采用七氟烷复合瑞芬太尼。记录3组患儿的拔管时间，比较入麻醉后监测治疗室（PACU）即刻和入PACU后5、15、30 min的躁动评分［采用苏醒期躁动量化评分表（PAED）和躁动5点分级法（EA评分）］。比较3组患儿术后30 min和术后2、6、12、24 h的东安大略儿童医院疼痛评分（CHEOPS）。记录3组患儿发生严重苏醒期躁动和PAED评分〉10分的例数及不良反应发生情况。结果 D1、D2组拔管时间长于对照组［（8.1±0.7）、（8.0±0.7）min比（6.8±0.9）min］，差异有统计学意义（P〈0.05）。D1组、D2组入PACU即刻和入PACU后5、15、30 min的EA评分均明显低于对照组［（3.25±0.44）、（1.00±0.00）分比（3.60±0.50）分，（3.00±0.00）、（1.00±0.00）分比（3.25±0.45）分，（2.75±0.44）、（1.25±0.51）分比（3.00±0.00）分，（2.00±0.00）、（2.00±0.51）分比（2.75±0.45）分］，D1、D2组入PACU后5、15 min的PAED评分明显低于对照组，差异均有统计学意义（均P〈0.05）。术后30 min和术后2、6、12 h，D1组、D2组的CHEOPS评分均明显低于对照组，且D2组明显低于D1组，差异均有统计学意义（均P〈0.05）。对照组、D1组、D2组发生严重苏醒期躁动的患儿分别为22例（44.0%）、13例（26.0%）、0例（0.0%），PAED评分〉10分的患儿分别为25例（50.0%）、20例（40.0%）、10例（20.0%）。3组患儿在PACU期间均无呼吸抑制发生。结论 0.2 mg/kg地佐辛能降低1-3岁幼儿瑞芬太尼复合七氟烷全身麻醉苏醒期躁动和术后疼痛评分，但气管导管拔除时间略有延长。

Objective To observe the effects of different dosages of dezocine on remifentanil-sevoflurane anesthesia recovery period in children. Methods Totally 150 children aged 1-3 years who had laparoscopic high ligation for inguinal hernia from July 2015 to September 2015 in Donghua Hospital of Dongguan were randomly divided into D1 group, D2 group and control group, with 50 cases in each group. During anesthesia induction, D1, D2 group had dezocine 0.1 mg/kg, 0.2 mg/kg respectively; the control group had isochoric 0.9% sodium chloride solution. Sevoflurane and remifentanil were used for anesthesia maintenance. Extubation time was recorded; Pediatric anesthesia emergence delirium scale（PAED） and Emergence agitation 5-points classification（EA） were scored at the entrance of postanesthesia care unit（PACU） and 5 min, 15 min, 30 min after entering PACU.Children′s hospital eastern ontario pain scale（CHEOPS） was scored at 30 min, 2 h,6 h,12 h,24 h after operation. Severe agitation and adverse reactions were observed. Results Extubation times in D1 and D2 groups were significantly longer than that in control group[（8.1±0.7）, （8.0±0.7）min vs （6.8±0.9）min, P〈0.05]. EA scores at the entrance of PACU and 5 min, 15 min, 30 min after entering PACU in D1 and D2 groups were significantly lower than those in control group[（3.25±0.44）, （1.00±0.00）scores vs （3.60±0.50）scores; （3.00±0.00）, （1.00±0.00）scores vs （3.25±0.45）scores; （2.75±0.44）, （1.25±0.51）scores vs （3.00±0.00）scores; （2.00±0.00）, （2.00±0.51）scores vs （2.75±0.45）scores]（P〈0.05）. PAED scores at 5 min, 15 min after entering PACU in D1, D2 group were significantly lower than those in control group（P〈0.05）. At 30 min, 2 h,6 h,12 h after operation, CHEOPS scores in D1 and D2 groups were significantly lower than those in control group, CHEOPS scores in D1 group were significantly lower than those in D2 group（all P〈0.05）. Severe agitation in control group and D1 group were 22 cases（44.0%） and 13 cases（26.0%） respectively; D2 group had no severe agitation case. There was no respiratory depression in PACU in 3 groups. Conclusions Dezocine 0.2 mg/kg is effective in releasing emergence agitation and postoperative pain during remifentanil-sevoflurane anesthesia recovery period in children aged 1-3 years, but the extubation time increases.