罗哌卡因局部浸润对全身麻醉下扁桃体摘除术后小儿躁动的影响

Effect of local infiltration of ropivacaine in general anesthesia on postoperative restlessness after pediatric tonsillectomy

目的观察罗哌卡因局部浸润对全身麻醉下扁桃体摘除术后小儿躁动的影响。方法将择期行扁桃体摘除手术的患儿100例，年龄5—10岁，采用随机数字表法分为罗哌卡因组（R组）和对照组（C组），每组50例。R组手术开始时先给0．25％罗哌卡因5ml于扁桃体周围浸润；C组手术开始时将等量生理盐水相同位置浸润。采用静吸复合全身麻醉。术中监测患者MAP、HR、SpO2，并于术后15min、30min、1h、4h访视患者，根据小儿麻醉苏醒期躁动量化评分表（pediatric anesthesia emergence delirium scale，PAED）评估术后躁动的严重程度，记录镇痛药物使用剂量、不良反应如恶心、呕吐、瘙痒、呼吸抑制等发生例数。结果术后躁动、疼痛评分、特殊事件及处理2组评分比较，R组明显低于C组，差异有统计学意义（P〈0．05）；PAED各时间点评分峰值2组间差异有统计学意义[（10～15分）R组9例，C组17例，P〈0．01；（15～20分）R组1例，C组5例，P≤0．01]。结论罗哌卡因局部浸润可以有效降低全身麻醉苏醒期躁动及并发症的发生率，值得在临床上推广。

Objective To investigate the effect of local infiltration with ropivacaine on postoperative restlessness after pediatric tonsillectomy. Methods One hundred cases of elective pediatric tonsillectomy patients aged for 5 to 10 years were enrolled. They were randomly divided into ropivacaine group（ R group） and control group（ C group） ,50 cases for each. R group were infiltrated with 5 ml 0.25 % ropivacaine around peritonsillar at the beginning of the operation;while C group were infiltrated with normal saline. The intraoperative MAP, HP, and SpO2 were monitored. The severity of postoperative restlessness were evaluated by PAED assessment model and the dose of analgesic drugs used, the number of the cases with adverse reactions such as nausea , vomiting, itching, and respiratory depression were recorded by visiting the patients at the time point of 15 min,30 min, 1 h ,4 h after operations. Results No significant differences（ P 〉 0.05 ） were observed be- tween the two groups in age,weight, gender and operation time. However, the PAED scores of respective time point ditfered significantly （ P 〈 0.05 ） between the two groups [ （ 10 - 15 scores） R group 9 cases, C group 17 cases, P 〈 0.01 ; （ 15 - 20 scores） R group 1 cases, C group 5 cases,P 〈 0.01 ]. Conclusion The incidences of restlessness and complications during the recovery period of sevoflurane anesthesia could be efficiently reduced by local infiltration with ropivacaine during which no adverse reactions were noticed and it might be worth of clinical promotion.