阿芬太尼在儿童口腔舒适化诊疗中的应用效果

Application effect of alfentanil in pediatric dentistry comfort diagnosis and treatment

目的 探讨阿芬太尼在儿童口腔舒适化诊疗中的临床疗效。方法 选择2022年12月至2023年3月全麻下择期行龋齿治疗患儿68例,随机数字表法将患儿分为2组(n=34):瑞芬太尼组(R组)和阿芬太尼组(A组)。2组患儿均使用静吸复合麻醉,R组采用瑞芬太尼1μg/kg诱导,0.08μg·kg^(-1)·min^(-1)维持至术毕;A组采用阿芬太尼15μg/kg诱导,0.375μg·kg^(-1)·min^(-1)维持至术毕。记录2组患儿在麻醉诱导前(T1)、喉罩置入前即刻(T2)、喉罩置入后即刻(T3)和术中安置预成冠时(T4)不同时点的心率(HR)、平均动脉压(MAP);记录2组患儿手术时间、手术结束后呼吸恢复时间,苏醒时间;2组患儿术中丙泊酚、七氟烷及补液量;2组患儿追加阿片类镇痛药物的例数;苏醒时FLACC疼痛评分、Steward镇静评分及术后不良反应发生率情况。结果 2组患儿T1~T4时间点HR水平比较,差异均无统计学意义(P>0.05);T1~T3时间点MAP水平比较,差异均无统计学意义(P>0.05);T4时间点R组MAP低于A组,且明显低于T1时间点MAP,降低幅度达27%(P<0.05);A组呼吸恢复时间明显快于R组,差异有统计学意义(P<0.05)。2组患儿手术时间、苏醒时间;术中丙泊酚、七氟烷及补液用量;追加阿片类镇痛药物的例数;苏醒时FLACC疼痛评分、Steward镇静评分及术后不良反应发生率比较,差异均无统计学意义(P>0.05)结论 阿芬太尼能够安全应用于儿童舒适化诊疗中,与瑞芬太尼相比,呼吸恢复时间明显缩短,循环抑制轻,更有利于术中循环稳定。

Objective To investigate the clinical effect of alfentanil on pediatric dentistry comfort diagnosis and treatment.Methods A total of 68 children managed by dental caries treatment under general anesthesia from December 2022 to March 2023 were enrolled in the study.They were randomly assigned into remifentanil group(group R) and alfentanil group(group A),with 34 children per group.Children in both groups were treated with combined intravenous and inhalation anesthesia.Anesthesia induction and maintenance in group R were performed using remifentanil 1μg/kg and remifentanil 0.08μg·kg^(-1)·min^(-1) until the end of the surgery,respectively.Anesthesia induction and maintenance in group A were performed using alfentanil 15μg/kg and alfentanil 0.375μg·kg^(-1)·min^(-1) until the end of the surgery,respectively.The heart rate(HR) and mean arterial pressure(MAP) before anesthesia induction(T1),before laryngeal mask insertion(T2),after laryngeal mask insertion(T3) and at the time of placing pre-formed crowns(T4) were recorded.Operation time,respiratory recovery time after the operation,and awakening time were recorded.Intraoperative dosages of propofol and sevoflurane and fluid infusion volume were recorded.Case number of additional uses of opioid analgesics was recorded.The Face,Legs,Activity,Cry,and Consolability(FLACC) and the Steward recovery scoring system at the awakening time,and the incidence of postoperative adverse events were recorded.Results There were no significant differences in HR levels at T1-T4 time point between the two groups(P>0.05).There were no significant differences in MAP levels at T1-T3 time points between groups(P>0.05).The MAP at T4 was significantly lower in group R than that of group A,and it was significantly lower than that at T1,with a decrease by 27%(P<0.05).The respiratory recovery time of group A was significantly shorter than that of group R(P<0.05).There were no significant differences in the operation time,awakening time,intraoperative dosages of propofol and sevoflurane,intraoperative fluid infusion volume,case number of additional uses of opioid analgesics,the FLACC and Steward recovery scoring system scores at the awakening time and incidence of postoperative adverse events between groups(P>0.05).Conclusion Alfentanil can be safely used in the comfortable diagnosis and treatment of children in dental clinic,which provides a shorter respiratory recovery time and milder circulation inhibition compared with those of remifentanil.It is more conducive to the stability of intraoperative circulation.