酮咯酸氨丁三醇与曲马多对小儿七氟醚全麻术后躁动的影响

Effects of ketorolac tromethamine and tramadol for prevention of emergence agitation after sevoflurane anaesthesia in children undergoing adenotonsillectomy

目的 观察酮咯酸氨丁三醇与曲马多对小儿七氟醚全麻术后躁动的影响.方法 选择全麻下行扁桃体和腺样体切除术的患儿80例,年龄2~7岁、ASAⅠ～Ⅱ级.根据手术结束前静脉注入的药物分为4组,每组20例,曲马多组（T组,手术结束前30 min静注曲马多1 mg/kg）,酮咯酸氨丁三醇组（K组,手术结束前30 min静注酮咯酸氨丁三醇0.5 mg/kg）,曲马多＋酮咯酸氨丁三醇组（T＋K组,手术结束前30 min静注曲马多1 mg/kg和酮咯酸氨丁三醇0.5 mg/kg）,对照组（C组,手术结束前30 min静注盐水5 mL）.记录各组手术时间、术后拔管时间,拔管后5 min（T5）、10 min（T10）的躁动评分,入PACU后记录疼痛和镇静评分,以及术后恶心呕吐的情况.结果 各组间患儿手术时间、拔管时间比较差异无统计学意义（P〉0.05）;T5和T10 2个时点的躁动发生率排序：C组〉T组〉T＋K组,C组〉K组〉T＋K组,差异有统计学意义（P〈0.05）.K组躁动发生率高于T组,但差异无统计学意义（P〉0.05）;入PACU后患儿疼痛评分排序：C组〉T组〉T＋K组,C组〉K组〉T＋K组,差异有统计学意义（P〈0.05）.K组疼痛评分高于T组,但差异无统计学意义（P〉0.05）;术后恶心呕吐发生率T组和T＋K组明显高于C组和K组（P〈0.05）.结论 酮咯酸氨丁三醇和曲马多可减轻术后疼痛,减少小儿七氟醚麻醉后躁动的发生.两种药物联合应用降低术后躁动的效果更显著.

Objective To investigate the effects of ketorolac tromethamine and tramadol for prevention of e- mergence agitation after sevoflurane anaesthesia in children undergoing adenotonsillectomy. Methods Eighty patients receiving sevoflurane for adenotonsillectomy procedure were randomly divided into 4 groups, 20 cases in each group. Tramadol group （group T, tramadol 1 mg/kg was administrated 30 min before the end of operation ）, ketorolac trometharnine group（ group K, ketorolac tromethamine 0. 5 mg/kg was administrated 30 rnin before the end of opera- tion）, trarnadol ＋ ketorolac trornethamine group（ group T ＋ K, tramadol 1 mg/kg and ketorolac tromethamine 0. 5 mg/ kg were administrated 30 min before the end of operation） , control group （group C, saline 5 mL was administrated 30 min before the end of operation）. Time of operation and extubation were recorded. Scores of pediatric emergence agitation were obtained at 5 rain and 10 rnin after extubation. Scores of pain and sedative were evaluated after entrance into PACU, and the prevalence of post-operative nausea and vomiting were observed. Results There was no significant difference in time of operation and extubation among the 4 groups （ P 〉 0. 05 ）. There were significant differences in scores of pediatric emergence agitation at T5 and T10 after extubation, with group C 〉 group T 〉 group T ＋ K and group C 〉 group K 〉 group T ＋ K（ P 〈 0. 05 ）. The sequence of pain scores of four groups was similar with emergence agitation, with group C 〉 group T 〉 group T ＋ K and group C 〉 group K 〉 group T ＋ K（ P 〈 0. 05 ）. The prevalence of nausea and vomiting was higher in group T and group T ＋ K than group C and group K （ P 〈 0. 05 ）. Conclusion Ketorolac tromethamine and tramadol can decrease the post-operative pain and the severity of emergence agitation after sevoflurane anaesthesia in children undergoing adenotonsillectomy. The combined effects of ketorolac trometharnine and tramadol are more significant than single use for prevention of emergence agitation.