舒芬太尼滴鼻对扁桃体切除术患儿全麻苏醒期躁动的影响

Effects of intranasal sufentanil on emergence agitation from general anesthesia during tonsillectomy and adenoidectomy in pediatric patients

目的对比鼻腔滴注不同剂量舒芬太尼对患儿全麻苏醒期躁动的影响。方法 60例ASAⅠ或Ⅱ级择期行扁桃体切除术患儿,随机分为3组,A组经鼻腔给予舒芬太尼0.5μg/kg(n=20);B组经鼻腔给予舒芬太尼0.3μg/kg(n=20);C组经鼻腔给予生理盐水0.5 m L(n=20)。A组和B组舒芬太尼均用生理盐水稀释至0.5 m L。记录手术时间、麻醉维持时间、苏醒时间及苏醒期躁动评分;记录术后1、2、4、8、12、24 h各时间点疼痛评分、血压、心率;记录术后恶心、呕吐、呼吸抑制等不良反应。结果躁动评分,A组低于B组和C组(P<0.05);疼痛评分,A组术后1、2、4、8、12、24 h均低于B组和C组(P<0.05);苏醒时间,A组长于B组和C组(P<0.05);各时间点血压及心率组间比较差异无统计学意义(P>0.05);术后呼吸抑制发生率,组间比较差异无统计学意义;A组和B组无恶心、呕吐发生,而C组5例患儿出现术后恶心呕吐。结论与鼻腔给予0.3μg/kg舒芬太尼相比,0.5μg/kg舒芬太尼鼻腔给药延长扁桃体切除术患儿苏醒期,但是其具有良好的镇痛,镇静效应,显著减少患儿苏醒期躁动。

Objective To compare the effects of different doses of intranasal sufentanil on emergence agitation from general anesthesia in pediatric patients. Methods Sixty ASAⅠ ~ Ⅱchildren undergoing selective tonsillectomy and adenoidectomy were randomly divided into 3groups. Group A received intranasal sufentanil 0. 5 μg / kg（ n = 20）,group B received intranasal sufentanil 0. 3 μg / kg（ n = 20） and group C received intranasal saline 0. 5 m L（ n =20）. Sufentanil used in group A and group B were diluted to 0. 5 m L with saline. Duration of surgery,anesthesia maintenance and recovery time were recorded. Emergence agitation score,pain score,BP and HR at postoperative 1 h,2 h,4 h,8 h,12 h and 24 h were also evaluated. Adverse reactions such as postoperative nausea and vomiting,respiratory inhibition were observed. Results Agitation score in group A was lower than that in group B and group C（ P〈0. 05）. Pain score at 1 h,2 h,4 h,8 h,12 h and 24 h after surgery in group A were decreased compared with group B and group C（ P〈0. 05）. Recovery time in group A was significantly longer than that in group B and C（ P〈0. 05）. No significant difference was found in BP and HR（ P〉0. 05）. There was no significant difference in the incidence of respiratory inhibition among the three groups. There were 5 children in group C suffered from postoperative nausea and vomiting,but none in group A and B. Conclusion Compared with 0. 3 μg / kg sufentanil,intranasal sufentanil 0. 5 μg / kg provide favorable sedation and analgesia effect and significantly ameliorated pediatric emergence agitation,though the recovery time is prolonged slightly.