不同药物治疗小儿麻醉苏醒期躁动的疗效分析

Analysis of the effect of different drugs on emergence agitation in children after general anesthesia

目的：观察氯胺酮、芬太尼与丙泊酚静脉注射对小儿外科手术麻醉后苏醒期躁动（emergency agitation,EA）的治疗效果。方法：选择全麻后出现苏醒期躁动的患儿90例,美国麻醉医师协会（ASA）Ⅰ~Ⅱ级,随机分为3组：氯胺酮组（K组）、芬太尼组（F组）和丙泊酚组（P组）,每组30例。3组分别给予静脉注射氯胺酮1mg/kg、芬太尼1μg/kg和丙泊酚1mg/kg。各组患儿分别在用药前后采用麻醉苏醒期躁动量化评分表（PAED）评分、东安大略儿童医院疼痛评分量表（CHEOPs）评分和Ramsay镇静评分评价治疗效果,同时记录各组用药后血氧饱和度（SpO2）〈90%、需要手控呼吸以及再次躁动的患儿数。结果：与用药前比较,用药后3组患儿的PAED评分和CHEOPs疼痛评分均显著下降（P〈0.05）,Ramsay镇静评分均显著升高。K组PAED评分低于F组和P组（P〈0.05）,CHEOPs评分低于P组（P〈0.05）,Ramsay镇静评分高于F组和P组;K组用药后发生呼吸抑制和再次躁动的患儿数均少于F组和P组。结论：1mg/kg氯胺酮能有效治疗患儿全身麻醉后苏醒期躁动的发生,且不良反应发生率小于芬太尼和丙泊酚。

Objective：To observe the effects of ketamine,fentanyl and propofol intravenous injection on emergency agitation（EA）in children after anesthesia in pediatric surgery.Methods： Ninety children who suffered from emergence agitation（ASA Ⅰ-Ⅱ）after general anesthesia were selected.They aged 2-7years old,weighed 12-31 kg,and the gender was not limited.They were randomly divided into 3groups：ketamine group（group K）,fentanyl group（group F）and propofol group（group P）,with 30 cases in each group.Intravenous injection of ketamine 1 mg/kg,fentanyl 1μg/kg and propofol1mg/kg in 3groups were given to three groups respectively.The degree of EA was evaluated using the Pediatric Anesthesia Emergence Delirium（PAED）Scale.Pain was assessed using the Children＇s Hospital of Eastem Ontario Pain Scale（CHEOPS）and sedation was recorded with Ramsay score.The respiratory depression（SpO290%）,the children who need breath control by hand,re-EA and duration of patient stay in post anesthesia care unit（PACU）after treatment were also recorded.Results：PAED and CHEOPs scores significantly decreased and Ramsay scores significantly increased in all groups（P〈0.05）after treatment.But PAED and CHEOPs values in group K was lower than that in the other two groups（P〈0.05）,and Ramsay values were higher in group K than those in the other two groups（P〈0.05）.PAED score of group K was lower than that of F group and P group（P〈0.05）,CHEOP score was lower than P group（P〈0.05）,and Ramsay sedation score was higher than F group and P group（P〈0.05）.The percent of respiratory depression,re-EA and duration of patient stay in PACU was lower in group K than in the other two groups after treatment.Conclusions：1mg/kg ketamine can safely and effectively treat the occurrence of EA in children after general anesthesia,and the incidence of adverse reaction is less than fentanyl and propofol.