不同药物对小儿扁桃体切除术术后躁动和镇痛的影响

A Comparison of the Anesthetic Effects of Dexmedetomidine,Parry Celebrex sodium and Tramadol for Children During Tonsillectomy

目的:观察对比右美托咪定、帕瑞昔布钠、曲马多分别对小儿扁桃体切除术术后躁动和镇痛的影响及安全性。方法:选择择期拟行扁桃体切除术患儿120例,随机分为右美托咪定组(A组)、帕瑞昔布钠组(B组)、曲马多组(C组)和生理盐水组(D组),每组30例。所有患儿均记录以下指标:不同时间点的SBP、DBP、HR和SpO2;拔管时间、清醒时间、躁动评分、改良面部表情评分、Ramsay镇静评分及24h内的不良反应。结果:SBP、DBP、HR与插管时比较,D组差异有统计学意义(P<0.05);改良面部表情评分D组最高(P<0.05);Ramsay镇静评分比较,D组明显低于A、B、C三组(P<0.05),C组在拔管后10min时明显高于A、B两组(P<0.05);躁动评分比较,D组高于A、B、C三组(P<0.05)。结论:右美托嘧啶、帕瑞昔布钠、曲马多均可安全有效用于小儿扁桃体切除术的镇静、镇痛,但右美托咪定具有更佳的镇静水平和抑制躁动作用。

Objective：To compare the anesthetic effects of Dexmedetomidine,Parry Celebrex sodium or Tramadol for children during tonsillectomy.Methods：120children aged 4to 10years,ASA gradedⅠorⅡ,scheduled for tonsillectomy under general anesthesia were randomly divided into Dexmedetomidine group（group A,n=30）,Parry Celebrex sodium group（group B,n=30）,Tramadol（group C,n=30）or Normal saline group（D,n=30）.The changes of SBP, DBP,HR and SpO2were recorded at the time point of intubation,extubation,1hor 4hafter extubation.The extubation time,palinesthesiav time,restlessness scores,improvement of facial expression score,ramsay sedation score and complication during 24hpostoperation were recorded.Results：The SBP,DBP or HR of patients in group D had a significant increase at the time of extubation or 1hpost extubation compared with group A,B or C（P〈0.05）.Compared with group A,B,or C,the patients in group D had a higher improvement of facial expression score after operation,in particular for 1hpost operation（P〈0.05）.The restlessness scores in group D increased significantly compared with group A,B or C at 10min,1hor 4hpost operation（P〈0.05）.Group D had a higher restlessness scores compared with the other three groups at the time of extubation or 10min,1h,4hpost extubation（P〈0.05）.Group B had a higher restlessness scores compared with group A or C 10min post extubation（P〈0.05）.Conclusion：Dexmedetomidine,Parry Celebrex sodium or Tramadol is safe and effective for children undergoing tonsillectomy.Notably,Dexmedetomidine has agreat effect on sedation and alleviating restlessness.