持续输注利多卡因对腺样体切除术患儿麻醉苏醒期躁动的影响

Effect of continuous infusion of lidocaine on agitation during anesthesia recovery in children undergoing adenoidectomy

目的观察术中持续静脉泵注利多卡因对腺样体切除术患儿麻醉苏醒期躁动的影响。方法选择2022年2月至6月在广东省妇幼保健院40例年龄在3~10岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级择期在七氟烷全身麻醉下行腺样体切除术的患儿,按照随机数字表法将患儿分为生理盐水对照组(N组)及利多卡因持续静脉泵注组(L组),每组各20例。N组男7例、女13例,年龄6(5,8)岁;L组男10例、女10例,年龄7(5,8)岁。患儿在诱导后,L组先静脉注射1 mg/kg利多卡因,继而以2 mg/(kg·h)持续静脉泵注利多卡因,N组给予等量生理盐水对照。主要结局指标包括躁动评分,躁动发生率,苏醒期麻醉药物追加次数;次要结局指标包括拔管后30 min疼痛评分,拔管时间及恢复室停留时间。采用独立样本t检验、Mann-Whitney U检验、Pearson Chi-Square检验。结果L组患儿苏醒期WATCHA躁动评分较N组患儿低[1(0,2)分比3(0,4)分,P<0.05],L组患儿躁动发生率低于N组[20%(4/20)比50%(10/20),P<0.05],L组患儿苏醒期麻醉药物追加率低于N组[15%(3/20)比60%(12/20),P<0.01]。L组患儿拔管时间短于N组[(13.00±7.33)min比(19.40±7.39)min,P<0.01],L组患儿恢复室停留时间短于N组[(42.00±7.85)min比(50.15±7.14)min,P<0.01],L组患儿拔管后30 min疼痛评分低于N组[0(0,2)分比2(0,2)分,P<0.05]。结论持续静脉泵注利多卡因可以减少腺样体切除术患儿麻醉苏醒期躁动的发生率,缩短拔管时间及恢复室停留时间,减轻术后疼痛,对加速患儿康复具有重要意义。

Objective To observe the effect of intraoperative continuous infusion of lidocaine on agitation during anesthesia recovery in children undergoing adenoidectomy.Methods A total of 40 children aged 3-10 years with American Society of Anesthesiologists(ASA)gradeⅠ-Ⅱundergoing pediatric adenoidectomy under general anesthesia with sevoflurane in Guangdong Women and Children Hospital from February to June 2022 were enrolled in this study,and were divided into a normal saline control group(N group)and a continuous infusion of lidocaine group(L group)according to the random number table method,with 20 cases in each group.There were 7 males and 13 females in group N,aged 6(5,8)years;there were 10 males and 10 females in group L,aged 7(5,8)years.After induction,group L was given intravenous injection of 1 mg/kg of lidocaine followed by continuous infusion of 2 mg/(kg·h)of lidocaine,whereas group N was given the same volume of normal saline.The primary outcome variables included the agitation score,number of agitation,and additional anesthetics during recovery;the secondary outcome variables included the pain score 30 minutes after extubation,extubation time,and length of postanesthesia care unit(PACU)stay.Independent sample t test,Mann-Whitney U test,and Pearson Chi-Square test were used.Results The WATCHA agitation score in group L during anesthesia recovery was lower than that in group N[1(0,2)vs.3(0,4),P<0.05],the incidence of agitation in group L was lower than that in group N[20%(4/20)vs.50%(10/20),P<0.05],and the rate of additional anesthetics during anesthesia recovery in group L was lower than that in group N[15%(3/20)vs.60%(12/20),P<0.01].The extubation time of group L was shorter than that of group N[(13.00±7.33)min vs.(19.40±7.39)min,P<0.01],the length of PACU stay of group L was shorter than that of group N[(42.00±7.85)min vs.(50.15±7.14)min,P<0.01],and the pain score 30 min after extubation in group L was lower than that in group N[0(0,2)vs.2(0,2),P<0.05].Conclusion Continuous infusion of lidocaine can reduce the incidence of agitation during anesthesia recovery in children undergoing adenoidectomy,shorten the time of extubation and length of PACU stay,and relieve the postoperative pain,which is of great significance for accelerating the children's recovery.