术后镇痛与家长陪伴对儿童麻醉苏醒期躁动的影响

Effects of post-operative analgesia combined with parental presence on emergence agitation after sevoflurane A anesthesia in children

目的探讨术后镇痛与家长陪伴对儿童麻醉苏醒期躁动的预防作用。方法60例急诊手术患儿，在其家属知情同意情况下，按术后是否镇痛及家长陪伴分成A组（20例）、B组（20例）、C组（20例），三组均采用七氟烷吸人诱导、气管插管后机械通气、骶管阻滞等麻醉方法，同时A组和B组均给予双氯酚酸钠栓（1mg／kg）纳肛，c组不使用双氯酚酸钠栓；术毕苏醒期间A组和C组患儿由护士监护治疗，而B组患儿在护士监护治疗的同时有家长陪伴。采用改良Aldrete评分、PAEDS评分和CHEOPS评分，观察比较三组患儿复苏情况、苏醒期躁动和术后疼痛进情况。结果三组苏醒时间差异无统计学意义（F=0．652，P〉0．05），苏醒期各时间段躁动发生率C组〉A组〉B组，20min及30min躁动发生率B组明显低于A组和c组（x2=4．566、7．234、4．124、6．126，均P〈0．05）；PACU留观时间C组明显短于A组和B组（F=6．881，P〈0．05）。三组各时段改良Aldrete评分差异无统计学意义（F=0．654，P〉0．05），各时点PAEDS评分B组均低于A组和C组（t=3．256、3．778、4．556、4．223，均P〈0．05），三组问CHEOPS评分差异无统计学意义（F=1．987，P〉0．05）。结论术后镇痛与家长陪伴能减少儿童麻醉后苏醒期躁动的发生。

Objeetlve To evaluate effects of post-operative analgesia combined with parental presence on e- mergence agitation after sevoflurane anesthesia in children. Methods 60 patients were randomly assigned into three groups with 20 cases each. After sevoflurane inhalation and being given rocuronium, all patients were intubated for me- chanical ventilation. Then patients received caudal block. Patiens in group A and B were treated with dielofenae sodi- tun suppositories before operation. To maintain anesthesia patients were adopted sevoflurane inhalation. Patients in group A and C were cared by nurses in post anesthesia care unit, whereas patients in group B added parental pres- ence. Emergence agitation incidence, modified Aldrete scale, PAEDS, CHEOPS were all recorded. Results Therewas no difference of modified Aldrete scale among three groups （F = 0.652 ,P 〉 0.05 ） , but emergence agitation incidence in group C was more than those of group A and B. At each point PAEDS scores of group B were lower than those of group C （X2 = 4. 566,7. 234,4. 124,6. 126, P 〈 0. 05 ）, also scores of group B were lower than those of group A at 10 min and 30 rain（ F = 0.654 ,P 〉 0.05 ）. PAEDS scores of group A were lower than those of group C at 20rain and 30min（ t = 3. 256,3. 778,4.556,4.223, all P 〈0.05 ）. At 20min and 30rain CHEOPS scores of group C were higher than those of group A and B （ F = 1. 987, P 〉 0. 05 ）. Conclusion Post-operative analgesia combined with parental presence could decrease the incidence of emergence agitation after sevoflurane anesthesia in children.