盐酸阿芬太尼注射液用于内镜下小儿扁桃体、腺样体等离子切除术的临床研究

Clinical study of alfentanil hydrochloride injection for endoscopic tonsillectomy and adenoidectomy in children

目的 探究盐酸阿芬太尼注射液用于内镜下小儿扁桃体、腺样体等离子切除术的临床疗效。方法 前瞻性选取2020年1月至2022年2月安徽省宿州市立医院120例内镜下小儿扁桃体、腺样体等离子切除术患儿作为研究对象,分组依据随机数字表法,观察组(丙泊酚+盐酸阿芬太尼麻醉)与对照组(丙泊酚+芬太尼麻醉)各60例。比较两组不同时间点[麻醉诱导前(T0)、气管插管前(T1)、气管插管后(T2)、术中(T3)、拔管前(T4)、拔管后(T5)]血流动力学指标,记录麻醉诱导给药后呛咳反应、复苏指标及术后不良反应。结果 两组患儿在T0、T1、T2、T3时段血压、心率比较,差异均无统计学意义(P>0.05),T4、T5时段,观察组收缩压、舒张压及心率为(104. 40±7. 77) mmHg、(61. 71±6. 60) mmHg、(89. 15±10. 61)次/min和(107. 85±9. 45) mm Hg、(64. 02±7. 40) mm Hg、(88. 12±9. 82)次/min,均低于对照组[(111. 82±11. 06) mm Hg、(66. 83±9. 10) mm Hg、(96. 20±15. 23)次/min和(118. 48±10. 27) mm Hg、(73. 83±8. 60) mm Hg、(99. 08±12. 80)次/min],差异均有统计学意义(P<0.05)。观察组呛咳发生率为5. 00%,明显低于对照组(35. 00%),差异有统计学意义(P<0.05)。观察组自主呼吸恢复时间、睁眼时间、拔管时间为(6. 85±2. 63)、(7. 28±3. 12)、(7. 43±3. 42) min,均短于对照组[(9. 27±3. 84)、(9. 92±4. 36)、(10. 12±4. 57) min],Steward评分为(4. 70±0. 83)分,高于对照组[(4. 12±0. 92)分],差异均有统计学意义(P<0.05)。观察组患儿不良反应发生率为6. 67%,低于对照组(25. 00%),差异有统计学意义(P<0.05)。结论 盐酸阿芬太尼注射液用于内镜下小儿扁桃体、腺样体等离子切除术麻醉,有利于维持围术期血流动力学稳定,呛咳发生率低,促进麻醉后复苏,不良反应少,值得推广。

Objective To explore the clinical efficacy of alfentanil hydrochloride injection for endoscopic tonsillectomy and adenoidectomy in children.Methods A total of 120 children with tonsillar and adenoid plasma resection under endoscope in Suzhou Municipal Hospital of Anhui Province from January 2020 to February 2022 were prospectiously selected as the study subjects.Patients were divided into two groups according to random number table method,including 60 children in the observation group(propofol+alfentanil hydrochloride anesthesia)and 60 children in the control group(propofol+fentanyl anesthesia).The hemodynamic indexes of the two groups at different time points[before anesthesia induction(T0),before endotracheal intubation(T1),after endotracheal intubation(T2),intraoperative(T3),before extubation(T4),after extubation(T5)]were compared,and the cough response,resuscitation indexes and postoperative adverse reactions after anesthesia induction administration were recorded.Results There was no statistically significant difference in blood pressure and heart rate between the two groups at T0,T1,T2,and T3(P>0.05),but the systolic,diastolic and heart rate between the observation group and the control group at T4 and T5 were(104.40±7.77)mmHg,(61.71±6.60)mmHg,(89.15±10.61)times/min and(107.85±9.45)mmHg,(64.02±7.40)mmHg,(88.12±9.82)times/min,which were lower than those of the control group[(111.82±11.06)mmHg,(66.83±9.10)mmHg,(96.20±15.23)times/min and(118.48±10.27)mmHg,(73.83±8.60)mmHg,(99.08±12.80)times/min],and the differences were significant(P<0.05).The incidence of choking cough in the observation group was 5.00%,which was significantly lower than that in the control group(35.00%),and the difference was statistically significant(P<0.05).The recovery time of spontaneous breathing,eye opening time,and extubation time in the observation group were(6.85±2.63),(7.28±3.12),and(7.43±3.42)min,which were shorter than those in the control group[(9.27±3.84),(9.92±4.36),(10.12±4.57)min],and the Steward score was(4.70±0.83)points,which was higher than that of the control group[(4.12±0.92)points],and the difference was statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 6.67%,which was lower than that in the control group(25.00%),and the difference was statistically significant(P<0.05).Conclusion Alfentanil hydrochloride injection is used for anesthesia in children undergoing endoscopic tonsillectomy and adenoidectomy.It is beneficial to maintain perioperative hemodynamic stability,promote post-anesthesia recovery,has significant analgesic effect,less adverse reactions,and can reduce the incidence of choking and is worthy of promotion.