术终给予单次剂量普鲁泊福对七氟烷麻醉下小儿腺样体切除术后躁动的影响

Effect of a single dose of propofol at the end of surgery on pediatric anesthesia emergence delirium undergoing adenotonsillectomy during sevoflurane anesthesia

目的 探讨术终给予单次剂量普鲁泊福对七氟烷麻醉下小儿腺样体切除术后躁动的影响.方法 择期行腺样体切除术患儿60例,根据抽签法随机分为普鲁泊福组和对照组,每组各30例,均采用七氟烷吸入诱导和维持,手术结束后立即停用所有麻醉药,普鲁泊福组静脉注射10%普鲁泊福1 mg/kg,对照组静脉注射等容量0.9%氯化钠.记录两组患儿的手术时间、七氟烷使用时间、麻醉时间、拔管时间、麻醉后恢复室（PACU）停留时间、拔管后30 min内的最高麻醉后躁动（PAED）评分和FLACC疼痛评分.结果 普鲁泊福组PAED评分明显低于对照组[（7.5±3.9）分比（10.9±4.5）分,P＜0.05].普鲁泊福组术后躁动发生率明显低于对照组[20.0%（6/30）比46.7%（14/30）,P＜0.05].普鲁泊福组术后拔管时间比对照组要稍微延长[（10.2±1.1）min比（9.1±1.5）min,P＜0.05].而两组麻醉时间、PACU停留时间、FLACC疼痛评分比较差异均无统计学意义（P＞0.05）.结论 小儿腺样体切除术麻醉中停用七氟烷后给予单次剂量1 mg/kg的普鲁泊福能明显降低术后躁动的发生,使麻醉更趋平稳,而并不会延长患儿麻醉时间和PACU停留时间,具有一定的临床应用价值.

Objective To investigate the effect of a single dose of propofol at the end of surgery on pediatric anesthesia emergence delirium undergoing adenotonsillectomy during sevoflurane anesthesia.Methods Sixty pediatric patients for adenotonsillectomy were randomly divided into propofol group and control group （30 cases in each group）, they were undergoing sevoflurane induction and maintaince. The pediatric patients in propofol group were received 1 mg/kg 10% of the propofol intravenous injection at the end of surgery,while the pediatric patients in control group were received the same volume physiological sailine intravenous injection. Duration of surgery, sevoflurane administration, anesthesia time, extubation time were recorded. The highest PAED score after extubation in 30 min were recorded. The time spent in PACU and the FLACC pain score were recorded. Results The PAED score in propofol group was significantly lower than that in control group [（7.5 ± 3.9） scores vs （10.9 ±4.5） scores, P〈0.05]. The incidence rate of postoperative delirium in propofol group was significantly lower than that in control group [20.0% （6/30） vs 46.7% （14/30）, P 〈 0.05 ] . Duration of extubation in propofol group was slightly longer than that in control group[（10.2 ± 1.1 ） min vs （9.1 ± 1 .5 ） min, P 〈 0.05].There was no statistical significant difference in duration of anesthesia, the time spent in PACU and the FLACC pain score （P 〉0.05）.Conclusions The administration a single dose of 1 mg/kg propofol at the end of surgery can effectively reduce pediatric anesthesia emergence delirium undergoing adenotonsillectomy during sevoflurane anesthesia, while can＇t extend the duration of anesthesia and the time spent in PACU. It has some clinical value.