小剂量镇静镇痛药预防小儿七氟烷麻醉术后躁动的临床观察

Clinical observation of low-dose drugs on preventing agitation in children received sevoflurane inhalation

目的探讨小剂量芬太尼、右美托咪定和氯胺酮用于预防小儿七氟烷麻醉术后躁动对呼吸循环系统功能和术后恢复质量的影响。方法选择美国麻醉医师协会（ASA）麻醉风险Ⅰ~Ⅱ级,拟择期于全麻下行斜视手术的患儿,随机分成对照组（Ⅰ）、芬太尼（ⅡF）、右美托咪定（ⅡD）和氯胺酮（ⅡK组）3个观察组。所有患儿均吸入8%七氟烷诱导并置入喉罩;3%七氟烷维持麻醉,保留自主呼吸。3个观察组在手术开始前分别给予芬太尼1μg/kg（ⅡF）、右美托咪定0.5μg/kg（ⅡD）和氯胺酮0.5 mg/kg（ⅡK）,I组则给予生理盐水10 ml。记录静脉给予药物或生理盐水前（0 min）、给药后5、10、15、20 min时的脉搏血氧饱和度（Sp O2）、潮气量（VT）、呼吸频率、呼气末二氧化碳分压（PET-CO2）。停药30 min后记录患儿躁动评分和恶心呕吐发生率。记录患儿在术后恢复室停留时间。结果 120例患儿纳入本研究,每组30例。ⅡF组患儿躁动发生率20.0%,ⅡD组13.3%,ⅡK组10.0%,均显著低于Ⅰ组发生率（46.7%,P均〈0.05）。恢复室停留时间依次为,ⅡK组（37.5±18.4）min,ⅡD组（35.6±16.1）min,ⅡF组（31.1±16.2）min,Ⅰ组（29.4±14.6）min,其中ⅡK组和ⅡD组明显长于ⅡF组和Ⅰ组（P〈0.05）。ⅡF组患儿的呼吸频率和分钟通气量在给药后5 min开始减慢,20 min时恢复至给药前水平。结论 1μg/kg芬太尼、0.5μg/kg右美托咪定和0.5 mg/kg氯胺酮均可安全用于小儿七氟烷麻醉,降低躁动的发生率,提高恢复期质量。芬太尼更适合在短小手术中使用。

Objective To evaluate the emergency quality of low-dose fentanyl,dexmedetomidine and ketamine on preventing agitation in children received sevoflurane inhalation and the impact on children＇s respiratory and circulation function.Methods The children received squint correction operation were randomly assigned into 4 groups：Ⅰ,ⅡF,ⅡD and Ⅱ K.All children were performed anesthetic induction with 8% sevoflurane and 5% oxygen followed by laryngeal mask airway（LMA） insertion.Anesthetic maintenance was performed with 3% sevoflurane and 2% oxygen,which allowed spontaneous ventilation.1μg/kg fentanyl in group Ⅱ F,0.5μg/kg dexmedetomidine in group Ⅱ D,0.5mg/kg ketamine in group ⅡK and saline in group Ⅰ were injected intravenously before the operation.The respiratory and circulatory parameters were recorded before and after medication in all groups.Emergency agitation score were recorded 30 min after discontinuing sevoflurane.Times for children staying in PACU were evaluated by Steward score.Results The incidences of agitation were lower in group Ⅱs（20.0% in ⅡF group,3.3% in ⅡD group,10.0% in ⅡK group） compared with group Ⅰ（46.7%,P〈0.05）;There were differences in staying time for children in PACU [ Ⅱ K group（37.5 ± 18.4）min,ⅡD group（35.6±16.1）min,ⅡF group（31.1±16.2）min,group Ⅰ（29.4±14.6）min;P〈0.05].Respiratory frequency and minute ventilation volume started to decrease 5 min after fentanyl medication in group ⅡF and returned to the level of premedication at 20 min after medication.Conclusion 1μg/kg fentanyl,0.5μg/kg dexmedetomidine and 0.5mg/kg ketamine could be used safely to decrease the incidences of agitation in children received sevoflurane and improve emergency quality.Fentanyl is more adequate for short-term operation.