阿芬太尼用于埋伏多生牙患儿舒适化口腔治疗的效果

Effect of alfentanil on oral comfort treatment in children with embedded supernumerary teeth

目的观察和比较阿芬太尼和瑞芬太尼用于埋伏多生牙患儿舒适化口腔治疗的效果。方法选择拟在舒适化口腔治疗门诊行上颌前牙区埋伏多生牙拔除术的患儿153例,男94例,女59例,年龄5~10岁,体重22~41 kg,ASAⅠ或Ⅱ级,预计手术时间≤1 h。采用随机数字表法将患儿分为三组:阿芬太尼组(A组)、瑞芬太尼组(R组)和对照组(C组),每组51例。入室后吸入8%七氟醚,待患儿意识消失后建立静脉通路,3 min后停止吸入七氟醚,置入喉罩,行压力控制同步间歇指令通气。A组持续吸入2%~4%七氟醚2 L/min,同时静注阿芬太尼10μg/kg,并以1μg·kg^(-1)·min^(-1)持续静脉泵注至术毕,手术结束时逐步降低七氟醚吸入浓度直至关闭挥发罐;R组静注瑞芬太尼2.5μg/kg,并以0.25μg·kg^(-1)·min^(-1)静脉泵注至术毕,余同A组;C组给予等容量的生理盐水,余同A组和C组。三组手术开始前,口腔科医师均采用3%甲哌卡因通过计算机控制口腔麻醉系统实施切口局部浸润麻醉。记录麻醉诱导前(T_(0))、喉罩置入前即刻(T_(1))、牙龈切开时(T_(2))、去骨时(T_(3))、手术结束时(T_(4))的HR、SBP和DBP。记录术中七氟醚用量、术后喉罩拔除时间、苏醒时间、离院时间和术者满意度、输液量及阿托品和多巴胺的使用情况。记录苏醒期躁动、术后恶心呕吐、头晕、嗜睡、瘙痒等术后不良反应的发生情况。结果与T_(0)时比较,T_(2)、T_(3)时C组HR明显增快,SBP和DBP明显升高(P<0.05);T_(1)—T_(4)时A组和R组HR、SBP和DBP差异无统计学意义。与C组比较,T_(2)、T_(3)时A组和R组HR明显减慢,SBP和DBP明显降低(P<0.05),A组和R组七氟醚用量和苏醒期躁动发生率明显降低(P<0.05)。与R组比较,A组和C组喉罩拔除时间明显缩短,A组苏醒期躁动发生率明显降低(P<0.05)。三组苏醒时间、离院时间、术者满意度、输液量、阿托品和多巴胺使用率以及术后恶心呕吐、头晕、嗜睡、瘙痒发生率差异无统计学意义。结论阿芬太尼可有效减轻埋伏多生牙患儿舒适化口腔治疗中的血流动力学波动,减少苏醒期躁动,减少七氟醚用量。

Objective To observe and compare the effect of alfentanil and remifentanil on oral comfort treatment in children with embedded supernumerary teeth.Methods A total of 153 children with embedded supernumerary teeth undergoing oral comfort treatment,94 males and 59 females,aged 5^(-1)0 years,weighing 22-41 kg,ASA physical statusⅠorⅡ,were randomly divided into three groups:alfentanil group(group A),remifentanil group(group R)and control group(group C),51 children in each group.After entering the operating room,all children were inhaled with 8%sevoflurane.After the children s consciousness disappeared,venous access was established.After 3 minutes,the inhalation of sevoflurane was stopped.A laryngeal mask was placed,and implement pressure-controlled synchronous intermittent mandatory ventilation was implement.Group A was inhaled with 2%-4%sevoflurane and 2 L/min fresh air flow,and given alfentanil 10μg/kg intravenously,and intravenous pumping was performed at a rate of 1μg·kg^(-1)·min^(-1) until the end of the operation.At the end of the operation,the inhaled concentration of sevoflurane was gradually reduced until the vaporizer tank was closed.Group R was given remifentanil 2.5μg/kg intravenously,and intravenous pumping was performed at a rate of 0.25μg·kg^(-1)·min^(-1) until the end of the operation,with the same other performance as in group A.The same volume of normal saline was given to group C,with the same other performance as in the previous two groups.Before the operation of the three groups,the stomatologists used 3%mepivacaine to perform local infiltration anesthesia through computer controlled oral anesthesia system.HR,SBP and DBP were recorded before induction of anesthesia(T_(0)),immediately before laryngeal mask placement(T_(1)),at the time of gingival incision(T_(2)),at the time of deboning(T_(3)),and at the end of surgery(T_(4)).The dosage of sevoflurane was recorded.Postoperative laryngeal mask extraction time,recovery time,discharge time,and surgeon satisfaction were recorded.Infusion volume,the use rate of atropine and dopamine.The incidence of postoperative adverse reactions such as restlessness during recovery,postoperative nausea and vomiting,dizziness,drowsiness,and itching were recorded.Results Compared with T_(0),HR,SBP and DBP were increased significantly in group C at T_(2) and T_(3)(P<0.05).Compared with T_(0),there was no significant difference in HR,SBP and DBP in groups A and R at T_(1) and T_(4).Compared with group C,HR,SBP and DBP were decreased significantly in groups A and R at T_(2) and T_(3)(P<0.05).Compared with group C,the dosage of sevoflurane and the incidence of agitation were decreased significantly in groups A and R(P<0.05).Compared with group R,the time of laryngeal mask removal was decreased significantly in groups A and C,the incidence of agitation were decreased significantly in group A(P<0.05).There was no significant difference in recovery time,discharge time,surgeon satisfaction,infusion volume,the use rate of atropine and dopamine,and the incidence of postoperative nausea and vomiting,dizziness,somnolence,and pruritus among the three groups.Conclusion Alfentanil can effectively reduce hemodynamic fluctuations,reduce emergence agitation,and reduce the amount of sevoflurane in oral comfort treatment for children with embedded supernumerary teeth.