布托啡诺预防小儿全麻苏醒期躁动的最佳剂量研究

Research of the optimal dose of butorphanol to prevent emergence agitation after general anesthesia in pediatrics

目的比较不同剂量布托啡诺静脉注射对预防小儿全麻苏醒期躁动的效果及安全性，探讨布托啡诺用于预防小儿全麻苏醒期躁动的最佳剂量。方法选择在七氟烷吸人全身麻醉下行择期腹腔镜手术的患儿120例，年龄6—12岁，美国麻醉医师协会（ASA）分级I-Ⅱ级。采用完全随机双盲法均分为布托啡诺10μg／kg组（B1组）、20μg／kg组（B2组）、30μg／kg组（B3组）和空白对照组（C组）。布托啡诺组患儿于手术结束前10min缓慢静脉注射相应剂量布托啡诺，C组注射等容积生理盐水。监测四组患儿术前（TO）、进入PACU时（T1）、进入PACU后5min（T2）、10min（T3）、15min（T4）、20min（T5）、出PACU时（T6）的心率（HR）、平均动脉压（MAP）、呼吸（RR）、血氧饱和度（SPO2）。记录拔管时间、苏醒时间和在PACU停留时间以及躁动评分、躁动发生率。记录患儿术后2、4、8hRamsay镇静评分及不良反应。结果与C组相比，B1组T1～T6时点的MAP、HR明显下降（P〈0．05）；B2和B3组T1-T5时点的平均动脉压、心率显著下降（P〈0．01）。与T0相比，B3组患儿T1～T3时点的MAP、HR明显下降（P〈0．05）。B1组术后中、重度躁动发生率低于C组（P〈0．05），B2组、B3组术后中、重度躁动发生率显著低于C组（P〈0．01）。B3组患儿的苏醒时间和在PACU停留时间长于其他3组（P〈0．05）；术后2、4hB3组镇静评分高于B1、B2组（P〈0．05），显著高于C组（P〈0．01）；B3组术后嗜睡发生率较其他3组显著增加（P〈0．05）。结论布托啡诺20μg／kg静脉注射对预防小儿全麻苏醒期躁动有良好的效果，同时能避免术后过度镇静。

Objective To compare the effect and safety of different dose of butorphanol intravenous injection and discuss the optimal dose of butorphanol to prevent emergence agitation after general anesthesia in pediatrics. Methods 120 cases （6-12 years old, ASA I - II ） were selected from patients who scheduled for laparoscopic surgery under sevoflurane general anesthesia. With a completely randomized and double blind method, they were divided into 4 groups： butorphanol 10 μ g/kg group （group B1）, butorphanol 20 μg/ kg group （group B2）, butorphanol 30 μ g/kg group （group B3） and placebo group （group C）. Group B1-B3 received corresponding dose of butorphanol 10 minutes before operation was over, while group C received the same volume of saline. Monitored HR, MAP, RR and SPO2 before operation （TO）, at the time entering PACU （T1）, 5, 10, 15, 20 minutes after entering PACU （T2-T5） and at the time going out of PACU （T6）. Recorded tracheal extubation time, recovery time, residence time of PACU and PAED. Recorded Ramsey sedation score 2, 4 and 8 hours after operation and adverse reactions. Results MAP, HR at T1-T6 in group B1 were significantly lower than those in group C （P 〈 0.05）; MAP, HR at T1-T5 in group B2 and B3 were significantly lower than those in group C （P 〈 0.01）. In group B3, MAP, HR at T1-T3 decreased significantly compared with those at TO （/9 〈 0.05）. The incidence of moderate and severe emergence agitation in group B1 was lower than thatin group C （P 〈 0.05）, the incidences of moderate and severe emergence agitation in group B2 and B3 were significantly lower than that in group C （P 〈 0.01）. Recovery time and residence time of PACU in group B3 were significantly longer than those in other 3 groups （P 〈 0.05）. Ramsay scores of 2, 4 hours after operation in group B3 were higher than those in group B1 and B2 （P 〈 0.05）, which were significantly higher than those in group C （P 〈 0.01）. The incidence of lethargy in group B3 was higher than that in other 3 groups （P 〈 0.05）. Conclusion The dose of 20 μ g/kg butorphanol has good effect in preventing emergence agitation, which can avoid excessive sedation as well.