羟考酮在小儿扁桃体、腺样体切除术中的应用

The application for oxycodone in pediatric tonsillectomy,adenoidectomy children

目的本实验旨在观察全身麻醉下羟考酮不同静注方案对患儿的影响。方法选择择期进行扁桃体、腺样体切除术3-6岁患儿120例,随机分为四组,每组30例。A组诱导时给予羟考酮0.1mg/kg;B组诱导时给予羟考酮0.2mg/kg;C组诱导时给予羟考酮0.3mg/kg;D组诱导时给予芬太尼5μg/kg;插管反应严重时追加瑞芬太尼0.1mg/kg。静脉诱导：丙泊酚3mg/kg、顺苯磺酸阿曲库铵0.1mg/kg,插入气管导管机械通气。分别记录患儿入室安静后5min（T0）、插管即刻（T1）的MAP、HR;拔管时间和拔管后的SpO2、RR。记录拔管时的躁动评分、术后1小时内意识状态警觉/镇静（OAA/S）评级、恶心、呕吐发生率及扁桃体术后出血程度。结果 A组T1与T0比较MAP、HR明显升高（P〈0.01）;B组、C组、D组T1与T0比较MAP、HR变化没有统计学差异（P〉0.01）。与D组相比,C组拔管时间明显延长（P〈0.01）;与D组相比,A组、B组拔管时间没有统计学差异（P〉0.01）。四组拔管后的SpO2、RR没有明显差异（P〉0.01）。拔管后躁动评分,A组、B组、C组明显低于D组（P〈0.01）。D组拔管后恶心、呕吐发生率明显高于A、B两组（P〈0.01）,与C组无明显差异。结论对于3-6岁接受扁桃体腺样体切除术的患儿,在诱导时给予0.2mg/kg的羟考酮是比较理想的注射方案。

Objective The experiment was designed to investigate the influence of general anesthesia intravenous oxycodone different programs for children. Methods Elective tonsillectomy, adenoidectomy surgical cases was 120. There were children and 3-6 years old, divided into four groups of 30 children randomly. Group A induction was given oxycodone 0. 1 mg/kg;Group B induction received oxycodone 0. 2mg Group C administered during the induction was oxycodone 0. 3mg/ kg ; Group D induction received fentanyl 5μg/kg; If severing was intubation, added fentanyl 0. 1 μg/kg. IV induction ： propofol 3mg/kg, cisatracurium besilate 0. 1 mg,/kg. Insert an endotracheal tube for mechanical ventilation. Record the children burglary quiet after 5 rain （ T0 ） , intubation （ T1 ） of MAP, HR; extubation time and after SpO2, and RR for extubation. Record agitation score after extubation,one hour after the state of consciousness alertness/sedation（OAA/S） rating, nausea,vomiting incidence and extent of bleeding after tonsillectomy. Results A group, MAP and HR for T1 to T0 was increased significant- ly（ P 〈 0. 01 ） ;Group B, C, and D, MAP and HR for T1 to TO was no difference statistically（ P 〉 0. 01 ） . Compared with group D, group C extubation time was significantly longer（ P 〈 0.01 ） ;Compared with group D, A, group B extubation time was no significant difference（ P 〉 0. 01 ） . After extubation, SpO2 and RR four groups was no significant difference （ P 〉 0. 01 ）. Restlessness score after extubation, group A, B and C was significantly lower than that in group D（ P 〈 0. 01 ） . After extubation,nansea,and vomiting group D were significantly higher than A and B groups （P 〈 0. 01 ）, but no significant difference with group C. Conclusion Receiving tonsillectomy adenoidectomy for 3 to 6 years old children,induced to give 0. 2mg/kg of oxycodone is an better injection programme.