术中给予氢吗啡酮对减少全麻小儿腺样体手术患儿苏醒期躁动的效果评价

Effect of Pretreatment with Hydromorphone on Reducing Emergence Agitation in Pediatric Adenoidectomy under Total Intravenous Anesthesia

目的:观察全麻小儿腺样体手术患儿术中给予氢吗啡酮后苏醒躁动减少的效果。方法:选取2016年7月-2017年7月于本院接受腺样体摘除术的患儿共88例,采用抓阄法将研究对象随机分为试验组(n=45)与对照组(n=43)。试验组给予0.01 mg/kg氢吗啡酮,对照组给予等体积0.9%氯化钠溶液,两组均于手术结束前15 min静脉注射。分别于苏醒时(T1),拔管时(T2),拔管后10 min(T3)、20 min(T4)、30 min(T5)、离开PACU时(T6)评价并比较两组儿童麻醉后躁动评分(PAED)、Ramsay镇静评分及FLACC疼痛评分。结果:试验组T1~T5 PAED评分均高于对照组(P=0.000)。试验组T1~T4Ramsay镇静评分均高于对照组(P=0.000);试验组T1~T6 FLACC疼痛评分均低于对照组(P=0.000)。结论:全麻小儿腺样体手术结束前15 min静脉注射氢吗啡酮0.01 mg/kg有良好的镇痛镇静效果,对预防患儿苏醒期躁动有一定的临床疗效。

Objective: To evaluate the effects on emergence agitation in pediatric adenoidectomy after pretreatment with Hydromorphone undertotal intravenous anesthesia. Method: A total of 88 children received pediatric adenoidectomy in our hospital from July 2016 to July 2017 were selected and randomly divided into experimental group(n=45) and control group(n=43) by lottery. The experimental group was given 0.01 mg/kg Hydromorphone. The control group was given 0.9% sodium chloride solution of equal volume. Both groups were given intravenous injection 15 min before the end of surgery. The score of pediatric anesthesia emergence delirium(PAED), Ramsay and FLACC between two groups were respectively compared at awakening(T1), extubation(T2), 10 min after extubation(T3), 20 min(T4), 30 min(T5), and leaving PACU(T6). Result: The PAED scores of T1-T5 in the experimental group was higher than those in the control group(P=0.000). Ramsay scores of T1-T4 in the experimental group were all higher than those in the control group(P=0.000). The FLACC scores of T1-T6 in the experimental group were lower than those in the control group(P=0.000). Conclusion: Intravenous injection of Hydromorphone 0.01 mg/kg at 15 min before the end of pediatric adenoidectomy under general anesthesia has a good analgesic and sedative effect, and has a certain clinical effect on preventing emergence agitation.