地佐辛对小儿扁桃体、腺样体切除手术全麻苏醒期躁动和谵妄的影响

Effect of dezocine on emergence agitation and delirium after general anesthesia in children undergoing tonsillectomy or adenoidectomy

目的观察地佐辛的不同给药方案对小儿扁桃体、腺样体切除手术麻醉苏醒期躁动(EA)和谵妄(ED)的影响。方法将择期行扁桃体、腺样体切除术的180例患儿,采用随机数字表法分为六组(n=30):A组诱导前静脉注射(简称静注)地佐辛0.1 mg/kg,手术结束时静注0.9%生理盐水(NS)5 mL;B组诱导前静注0.9%NS 5 mL,手术结束时静注地佐辛0.1 mg/kg;C组诱导前静注地佐辛0.05 mg/kg,手术结束时静注0.9%NS 5 mL;D组诱导前静注0.9%NS 5mL,手术结束时静注地佐辛0.05 mg/kg;E组诱导前静注地佐辛0.05 mg/kg,手术结束时静注地佐辛0.05 mg/kg;F组(对照)诱导时与手术结束时均静注0.9%NS 5 mL。记录各组手术时间、拔管时间、清醒时间;对比拔管即刻、拔管后10 min、20 min、30 min的小儿麻醉苏醒期谵妄(PAED)量表评分及五分量表(5-point scale)评分,EA和ED及不良反应发生率。结果拔管即刻、拔管后10 min、20 min、30 min B组PAED评分、5-point scale评分均明显低于其他五组;拔管即刻、拔管后10 min、20 min F组PAED评分、5-point scale评分明显高于其他五组(均P<0.05)。EA和ED发生率,B组明显低于其他组,而F组则明显高于其他组(均P<0.05)。结论小儿扁桃体、腺样体切除术中采用丙泊酚与瑞芬太尼复合静脉麻醉结束时静注地佐辛0.1 mg/kg对患儿EA和ED的预防作用更佳,不影响拔管时间、清醒时间,不良反应少,值得临床选用。

Objective To investigate the effect of different dosage regimens of dezocine on emergence agitation(EA) and emergence delirium(ED) after anesthesia in children undergoing tonsillectomy or adenoidectomy. Methods A total of 180 children undergoing elective tonsillectomy or adenoidectomy were divided into six groups(n=30): group A undertook intravenous injection of dezocine( 0.1 mg/kg) before induction and received intravenous injection of 0.9% normal saline(NS, 5 mL) after operation;group B undertook intravenous injection of 0.9% NS(5 mL) before induction and received intravenous injection of dezocine(0.1 mg/kg) after operation;group C undertook intravenous injection of dezocine(0.05 mg/kg) before induction and received intravenous injection of 0.9% NS(5 mL) after operation;group D undertook intravenous injection of 0.9% NS(5 mL) and received intravenous injection of 0.05 mg/kg dezocine after operation;group E undertook intravenous injection of 0.05 mg/kg dezocine before induction and after operation, and group F(the control group) received intravenous injection of 0.9% NS(5 mL) during induction and at the end of operation. Operation duration, extubation time, and recovery time were recorded in each group, and the pediatric anesthesia emergence delirium(PAED) scale scores and the 5-point scale score at the moment of extubation,10, 20 and 30 minutes after extubation were compared among groups, and EA, ED as well as the incidence rate of adverse reactions were compared as well. Results Compared to the other five groups, group B obtained significantly lower PAED scores and 5-point scale scores at the moment of extubation, 10, 20 and 30 minutes after extubation;group F yielded significantly higher PAED scores and 5-point scale scores at the moment of extubation, 10 and 20 minutes after extubation(all P<0.05). Group B presented significantly lower incidence rates of EA and ED, and group F obtained prominently higher incidence rates of EA and ED as compared to the other 5 groups(all P<0.05). Conclusion Intravenous injection of 0.1 mg/kg dezocine exerts better preventive effect on EA and ED after intravenous anesthesia using propofol and remifentanil in children undergoing tonsillectomy or adenoidectomy, which does not affect extubation time or recovery time, has few adverse reactions, and is worthy of clinical recommendation.