围术期多模式处理对小儿全麻苏醒期躁动及术后行为改变的影响

Effects of Perioperative Multimodal Treatment on Emergence Agitation and Negative Postoperative Behavioural Changes in Pediatric General Anesthesia

目的:探讨围术期多模式处理对小儿全麻苏醒期躁动(EA)及术后行为改变(NPOBCs)的影响。方法:选择2016年9月至2017年7月在我院行择期下腹部手术患儿200例,年龄1～6周岁,美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级,将患儿随机分为多模式处理组(M组)和常规处理组(C组),各100例。M组:术前1 d对患儿进行心理指导;术前2 h口服5%葡萄糖5 ml/kg;入室前静脉注射咪达唑仑0.02 mg/kg;术中不使用七氟烷;术毕给予0.25%罗哌卡因局部浸润伤口;术后在麻醉后复苏室(PACU)内安慰;完全清醒后给予少量温开水。C组给予常规处理。记录术前禁饮时间、手术时间、拔除喉罩时间、拔除喉罩后改良加拿大东安大略儿童医院疼痛评分(m-CHEOPS)、拔除喉罩后5 min和15 min躁动评分(PAED)及EA发生率;术后1 d、1周、1个月患儿NPOBCs发生情况。结果:与C组比较,M组患儿拔除喉罩后m-CHEOPS评分,拔除喉罩后5 min、15 min PAED评分和EA发生率,术后1 d NPOBCs发生率均明显降低(P<0.05或0.01);2组术后1周、1个月NPOBCs发生率差异无统计学意义(P>0.05)。结论:围术期多模式处理对小儿全麻苏醒期EA有预防作用,同时可减少拔除喉罩后m-CHEOPS评分以及术后1 d NPOBCs的发生率。

Objective： To investigate the effects of perioperative multimodal treatment on the emergence agitation （EA） and negative postoperative behavioural changes （NPOBCs） in pediatric general anesthesia. Methods： A total of 200 children underwent abdominal surgery from Sep 2016 to Jul 2017, aged 1-6 years old, American Society of Anesthesiologists （ASA） grade I and grade II , were randomly divided into multimodal treatment group （group M） and routine treatment group （group C）, 100 cases in each group. Group M was given psychological guidance at 1 d before surgery, oral 5% glucose 5 ml/kg at 2 h before surgery, intravenous injection of midazolam 0.02 mg/kg before entering the operating room, but was not given sevoflurane during surgery. Group M was also given local infiltration of the operative wound with 0.25% ropivacaine at the end of the surgery, comfort in the post-anesthesia care unit （PACU） after surgery, and a small amount of liquid after clear consciousness. Group C was treated with routine anesthesia operation. Modified Children＇s Hospital of Eastern Ontario Pain Scale （m-CHEOPS） after extubation, pediatric anesthesia emergence delirium （PAED） score and incidence of EA at 5 and 15 min after extubation, and incidence of NPOBCs at 1, 7 and 30 d after surgery were recorded and compared. Results ： Compared with group C, m-CHEOPS score, PAED score and incidence of EA at 5 and 15 min after extubation, incidence of NPOBCs at 1 d after surgery significantly decreased in group M （P〈0.05 or 0.01）. The incidence of NPOBCs at 7 and 30 d in the two groups were not statistical difference （P 〉 0.05）. Conclusion： Perioperative multimodal treatment has a preventive effect on EA in pediatric general anesthesia, and can reduce the m-CHEOPS score after extubation and the incidence of NPOBCs at 1 d after surgery.