预注帕瑞昔布钠防治小儿七氟烷麻醉苏醒期躁动的临床研究

The effect of pre-injection of parecoxib sodium on emergence agitation in children with sevoflurane anesthesia

目的：观察预注帕瑞昔布钠对小儿七氟烷麻醉苏醒期躁动的影响。方法：选择120例行择期腭裂修补术患儿,七氟烷维持麻醉,采用随机数字表法将患儿分成4组,各30例,分别为：低剂量帕瑞昔布钠组（ L组）、中剂量帕瑞昔布钠组（ M组）、高剂量帕瑞昔布钠组（H组）和对照组（C组）。 L、M、H和C组分别于麻醉诱导前静脉注射帕瑞昔布钠0.5 mg/kg、帕瑞昔布钠0.75 mg/kg、帕瑞昔布钠1 mg/kg（剂量≤40 mg）及等容量0.9%氯化钠注射液。面罩吸氧（6 L/min）＋8%七氟烷诱导,静脉注射咪达唑仑0.05 mg/kg,维库溴铵0.1 mg/kg,芬太尼3μg/kg行气管插管；2%～3%七氟烷维持麻醉直至手术结束,术毕立即停止吸入。记录术中情况、苏醒期躁动情况以及疼痛和镇静程度,并记录术后24 h不良反应。结果：4组患儿麻醉、手术、拔管和麻醉后监测治疗室停留时间差异均无统计学意义（P〉0.05）；4组患儿苏醒期躁动发生情况比较,M组和H组患儿躁动发生率均低于C组（P〈0.05）,而L、M、H组小儿麻醉后躁动量表（PAED）评分均明显低于C组（P〈0.01）；M组和H组PAED评分均低于L组（P〈0.05）；与M组比较,H组躁动发生率及PAED评分差异均无统计学意义（P〉0.05）。4组患儿疼痛评分（FLACC）及Ramsay评分比较,与C组比较,L、M和H组患儿术后各时点FLACC评分均明显降低（P〈0.01）,而3组患儿术后Ramsay评分均升高（P〈0.05～P〈0.01）；与L组比较,M组和H组T0和T1时点FLACC评分均降低（P〈0.05～P〈0.01）,M组和H组T1和H组T2时点Ramsay评分升高（P〈0.05～P〈0.01）；与M组比较,H组各时点FLACC评分及T0与T1时点Ramsay评分差异均无统计学意义（P〉0.05）,而H组T2时点Ramsay评分明显高于M组（P〈0.01）；4组患儿头疼、头晕、呼吸抑制等不良反应差异无统计学意义（P〉0.05）。结论：预注帕瑞昔布钠可安全有效地预防患儿七氟烷麻醉苏醒期躁动的发生,并且无明显不良反应,而预注帕瑞昔布钠0.75 mg/kg是临床预防小儿苏醒期躁动较理想的选择。

Objective：To observe the effects of pre-injection of parecoxib sodium on emergence agitation in children with sevoflurane anesthesia. Methods：One hundred and twenty children scheduled by cheft palate repair treated with sevoflurance anesthesia were randomly divided into the low dose parecoxib sodium（ L group） ,medium dose parecoxib sodium（ M group） ,high dose parecoxib sodium （H group） and control group（C group） （30 cases each group）. Before induction of anaesthesia,the L,M,H and C group were intravenously injected using 0. 5 mg/kg parecoxib,0. 75 mg/kg parecoxib,1 mg/kg parecoxib and 0. 9% normal saline,respectively. All cases were induced with oxygen mask（6 L/min） combined with 8% sevoflurance,and then were treated with 0. 05 mg/kg midazolam, 0. 1 mg/kg vecuronium and 3 μg/kg fentanyl by intravenous injection. The patients were endotracheally intubated and maintained anaesthesia using 2% to 3% until the end of operation. The operation condition,emergence agitation,pain,sedation and adverse reaction after 24 h of operation were recorded. Results：The differences of the anesthesia time,operation time,extubation time and PACU stay time between four groups were not statistically significant（P〉0. 05）. The incidences of the agitation in M group and H group were lower than that in C group（P〈0. 05）. The PAED scores in L,M and H groups after anesthesia were significantly lower than that in C group（P〈0. 01）,whose in M and H groups were lower than that in L group（P〈0. 05）,and the differences of the incidences of the agitation and PAED scores between M and H group were not statistically significant（P〉0. 05）. Compared with the FLACC and Ramsay scores in C group,whose in L,M and H group decreased and increased significantly,respectively（P〈0. 05 to P〈0. 01）. Compared with the L group,the FLACC scores in M and H groups at T0 and T1 decreased（P〈0. 05 to P〈0. 01）,and the Ramsay scores in M and H groups at T1 and H group at T2 increased（P〈0. 05 to P〈0. 01）. The differences of between the FLACC scores at each point and Ramsay scores at T0 and T1 in H group,and M group were not statistically significant（P〉0. 05）,but the Ramsay score in H group at T2 was significantly higher than that in M group（ P〈0. 01）. The differences of headache,dizziness and respiratory depression between four groups were not statistically significant（P〉0. 05）. Conclusions：The pre-injection of parecoxib sodium can effectively prevent the occurrence of emergence agitation and obvious adverse reaction in children with sevoflurane anesthesia. The pre-injection of 0. 75mg/kg parecoxib sodium in preventing the emergence agitation in children.