小剂量纳洛酮协同新斯的明用于婴幼儿全身麻醉复苏的临床观察

Clinical Observation of Small Dose of Naloxonesynergistic with Neostigmine Used for Infants and Young Children Under General Anesthesia Recovery

目的研究小剂量纳洛酮协同新斯的明对婴幼儿全身麻醉复苏时间、血流动力学和拔管后不良反应的发生率的影响。方法选择气管插管全麻婴幼儿54例,随机分为纳洛酮组、阿托品组和生理盐水组(对照组),在手术结束、自主呼吸恢复后,纳洛酮组的患儿给予纳洛酮2μg/kg复合新斯的明20μg/kg静脉注射,阿托品组的患儿给予阿托品10μg/kg复合新斯的20μg/kg静脉注射,对照组的患儿给予生理盐水静脉注射,分别观察和记录给药后患儿血流动力学参数,记录并比较患儿自然睁眼时间、拔管时间及离开手术室时间、气管拔管后的不良反应发生率。结果给药后三组病人的血流动力学参数差异均无统计学意义(P>0.05),与对照组相比,纳洛酮组及阿托品组患儿自主睁眼时间、拔管时间和出室时间明显缩短差异有统计学意义(P<0.05),拔管后氧饱和度下降的发生率明显降低差异有统计学意义(P<0.05);与阿托品组相比,纳洛酮组患儿自主睁眼时间、拔管时间和出室时间明显缩短差异有统计学意义(P<0.05),拔管氧饱和度下降的患儿发生率明显降低差异有统计学意义(P<0.05)。结论小剂量的纳洛酮协同新斯的明可以加快婴幼儿的麻醉苏醒和缩短拔管时间,减少拔管后氧饱和度的发生率,对血流动力学无明显影响。

Objective To study effect of small dose of naloxone synergistic with neostigmine on general anesthesia recov-ery ,hemodynamic changes and incidence of adverse effects after extubation. Methods 54 infants and children scheduled for gen-eral anesthesia with intubation were divided randomly into naloxone group,atropine group and control group. When the children re-gained natural respiratory at the end of operation,chindren in naloxone group were intravenously injected of naloxone 2μg/kg and neostigmine 20μg/kg; chindren in atropine group were intravenously injected of atropine 10μg/kg and neostigmine 20μg/kg, chindren in control group were intravenously injected of 5ml normal saline. after injection, hemodynamic parameters were recorded and compared . Time to natural eye-opening （ teo） ,time to tracheal extubation（ te） , time to leave operation room（ tl） and inci-dence of adverse effects were observed and compared . Results There were no obvious difference in homedynatics parameters af-ter injection（P〉0. 05）. Compared with control group, time to natural eye-opening, time to tracheal extubation and time to leave operation room were apparently shorter in naloxone group and atropine group （P〈0. 05）. Incidence of oxygen desaturation is obivi-ously lower （P〈0. 05）. Compared with atropine group, time to eye-opening,time to tracheal extubation and time to leave opera-tion room were apparently shorter in naloxone group （P〈0. 05）. Incidence of oxygen desaturation is obiviously lower （P〈0. 05）. Conclusion Small dose of naloxone and neostigmine can speed up general anesthesia recovery of infants and young children and reduce the incidence of oxygen desaturation but has no influence on hemodynamic parameter.