小儿扁桃体切除术毕前应用芬太尼对瑞芬太尼复合丙泊酚静脉麻醉的镇痛研究

The analyestic effect of Fentanyl application on Remifentanyl-Propofol anesthesia recovery before the end of surgery tonsillectomy in children

目的探讨小儿扁桃体切除术毕前应用芬太尼对瑞芬太尼复合丙泊酚麻醉镇痛的效果。方法 30例患儿实施小儿扁桃体切除术随机均分成Fl、F2和N组,术毕前分别给予F1,F2组芬太尼1μg/kg,2μg/kg,N组为对照组,评定拔管后疼痛和镇静程度,记录呼吸恢复、意识恢复和拔管时间以及拔管后的不良事件,连续监测MAP和HR。结果 F1和F2组的VAS评分较N组显著降低(P<0.01),两组Ramsay评分显著高于N组(P<0.01),且F2较F1显著增高(P<0.05)。F2组的呼吸恢复、意识恢复和拔管时间与F1和N组相比均明显延长(P<0.01)。N组的MAP和HR在恢复过程中逐渐升高,而F1和F2组的MAP和HR变化相对较平稳。结论在小儿扁桃体切除术结束前应用1μg/kg芬太尼可减轻瑞芬太尼停药后的疼痛反应,但不显著延迟苏醒和拔管时间。

Objective To discuss the analgestic effect of Fentanyl application on Fentanyl-Propofol anesthesia recovery before the end of surgery tonsillectomy in children. Methods Thirty cases of pediatric tonsillectomy were divided into F1,F2 and N groups,1 μg/kg or 2 μg/kg fentanyl were given before skinning suture in F1 or F2 group,N group as control group.The degree of pain and sedation were assessed,recovery time of breathing,consciousness recovery,extubation time and the adverse events were recorded,MAP and HR were continuing monitored. Results Compared with N group, score of VAS grade in F1 and F2 groups were significantly reduced（P〈0.01）.Score of ratings ramsay in F1 and F2 group were higher than in N group（P〈0.01）,and increased more significantly in F2 group（P〈0.05）.Compared with F1 and N group,recovery time of breathing,consciousness recovery and extubated time were extended in F2 group（P〈0.01）.During recovery,MAP and HR were gradually increased in N group,and remained relatively stable in F1 and F2 groups.Conclusion Before the end of surgery tonsillectomy in children,application of 1 μg/kg fentanyl could reduce pain response of remifentanyl discontinuation,but not significantly delay recovery of consciousness and extubated time.