地佐辛超前镇痛对隐匿性阴茎矫治术患儿苏醒期谵妄的临床观察

Preemptive Analgesic Effects of Dezocine on Emergence Delirium in Children Undergoing Concealed Penis Correction:a Clinical Observation

【目的】观察地佐辛超前镇痛对隐匿性阴茎矫治术患儿苏醒期谵妄(ED)的影响。【方法】筛选2020年7月至2020年10月62例6~10岁拟行隐匿性阴茎矫治术的男孩,按随机数字表法分为生理盐水对照组(C组,n=32例)和地佐辛组(D组,n=30例),所有患者均采用静吸复合全麻(喉罩)。2组分别在麻醉诱导前5 min给予等容量的0.9%生理盐水10 mL或地佐辛0.1 mg/kg(0.9%生理盐水稀释至10 mL)。比较2组入PACU即刻(T1)、10 min(T2)、出PACU即刻(T3)、术后1 h(T4)、术后6 h(T5)PAED评分及FLACC疼痛评分;比较2组术后ED、导尿管相关膀胱不适(CRBD)发生率。问卷患儿父母术后48 h内新发适应不良行为发生情况并比较;比较2组麻醉诱导前30 min(T0)、T1、T4、T5外周静脉血皮质醇(Cor)、肾上腺素(E)、血糖(Glu)水平。【结果】D组在T2~T5点PAED评分明显低于C组(P<0.001);FLACC评分低于C组(P<0.001);D组ED的发生率明显低于C组(16.67%vs.40.63%,P=0.039),术后48 h内新发适应不良行为的总发生率低于C组(13.33%vs.37.50%,P=0.042);CRBD发生率低于C组(6.67%vs.28.13%,P=0.044)。D组在T1、T4、T5点E、Cor、Glu水平明显低于C组(组间P值分别为P<0.001,P=0.009,P=0.012)。【结论】地佐辛超前镇痛可明显降低小儿隐匿性阴茎术后ED的发生率;降低术后新发适应不良行为的发生率,可能与地佐辛降低术后疼痛应激及CRBD的发生率有关。

【Objective】To observe the preemptive analgesic effects of dezocine on emergence delirium(ED)in children undergoing concealed penis correction.【Methods】Sixty-two 6~10 years old boys scheduled for concealed penis correction under general anesthesia from July 2020 to October 2020 were randomly divided into normal saline control group(Group C,n=32)and dezocine group(Group D,n=30).Five minutes before the anesthetic induction,Group C was treated with 10 mL of 0.9%normal saline and Group D with same amount of dezocine 0.1 mg/kg(diluted to 10 mL by 0.9%saline).Pediatric Anesthesia Emergence Delirium scale(PAED)scores and Face,Legs,Activity,Cry,Consolability scale(FLACC)scores of the two groups were recorded and compared at the time points of entering postanesthesia care unit(PACU)(T1),10 min after entering PACU(T2),leaving PACU(T3),1 h(T4)and 6 h(T5)after the surgery.The postoperative incidence of ED and urinary catheter-related bladder discomfort(CRBD)were compared between the two groups.Newly occurred maladaptive behaviors within 48 h after surgery were documented by parents in a questionnaire and compared between the two groups.We also compared the levels of cortisol,epinephrine and blood glucose at 30 min before induction(T0),T1,T4 and T5 between the two groups.【Results】PAED scores and FLACC scores at T1 to T5 in Group D were significantly lower than those in Group C(both P<0.001).Group D had lower incidence of ED(16.67%vs.40.63%,P=0.039),CRBD(6.67%vs.28.13%,P=0.044)and newly occurred maladaptive behaviors within 48 h after surgery(13.33%vs.37.50%,P=0.042).The levels of cortisol,epinephrine and glucose were significantly lower in Group D at T1,T4,T5(P<0.001,P=0.009 and P=0.012,respectively)than those in Group C.【Conclusions】Preemptive analgesia by using dezocine can significantly reduce the the incidence of ED and newly occurred maladaptive behaviors in children undergoing concealed penis correction,which could be explained by the fact that dezocine can reduce the postoperative pain stress and the incidence of CRBD.