阿芬太尼对七氟烷全麻下扁桃体摘除手术患儿麻醉苏醒质量及术后疼痛的影响

The effect of alfentanil on the quality of anesthesia recovery and postoperative pain in children undergoing tonsillectomy under sevoflurane general anesthesia

目的小儿全麻扁桃体摘除手术术后易诱发苏醒期躁动,本研究探讨阿芬太尼对七氟烷全麻下扁桃体摘除手术患儿麻醉苏醒质量及术后疼痛的影响。方法选择2022-09-02-2023-08-18潍坊医学院附属医院接受择期全麻下行扁桃体切除术患儿120例,按照随机数字表法随机分为A、B和C 3组,每组40例。A组为空白对照组,术中全凭七氟烷麻醉;B组为阿芬太尼组,术中阿芬太尼联合七氟烷麻醉;C组为阿芬太尼复合右美托咪定联合七氟烷麻醉。主要观察指标为患儿术后躁动发生情况:拔管即刻(E0)、拔管后5 min(E5)、拔管后10 min(E10)术后苏醒期躁动量表(PAED)评分、术后躁动发生率。次要结局指标:患儿自主呼吸恢复时间、术后拔管时间、麻醉后监测治疗室(PACU)停留时间,记录患儿疼痛评估面部、腿部、活动、哭闹和可安慰度(FLACC)量表评分、追加镇痛药情况、不良反应的发生率。结果在E0,E5,E103个不同时间点,PAED评分B组(9.6±2.2)、(6.6±2.0)、(5.0±1.8)分和C组(9.0±1.6)、(6.2±1.5)、(4.9±1.2)分与A组(11.8±2.2)、(9.3±2.2)、(7.3±1.9)分相比显著降低,差异有统计学意义,均P<0.05;与A组(30%)相比,B组(10%)和C组(5%)术后躁动发生率均显著降低,差异有统计学意义,χ^(2)=10.980,均P<0.05。C组术后自主呼吸恢复时间(15.1±2.3)min、拔管时间(17.8±2.6)min、PACU停留时间(48.2±5.7)min与A组术后自主呼吸恢复时间(9.0±1.7)min、拔管时间(10.8±1.9)min、PACU停留时间(39.4±5.8)min相比显著延长,差异有统计学意义,均P<0.05;FLACC评分B组(2.4±1.0)分和C组(2.0±0.8)分与A组(4.7±1.3)分相比显著降低,追加阿芬太尼的患儿例数及呛咳发生率均显著降低,差异有统计学意义,均P<0.05;与A组(10%)和B组(13%)相比,C组(21%)的嗜睡发生率显著增高,差异有统计学意义,χ^(2)=6.962,P<0.05。结论阿芬太尼用于七氟烷全麻小儿扁桃体切除术中,可有效提升麻醉苏醒质量,防止术后躁动发生,值得临床应用及推广。

Objective Pediatric general anesthesia for tonsillectomy is prone to induce agitation during the awakening period in the postoperative period,and this study investigates the effect of alfentanil on the quality of anesthesia recovery and postoperative pain in children undergoing tonsillectomy under sevoflurane general anesthesia.Methods Totally 120 children with tonsillectomy under general anesthesia in the Affiliated Hospital of Weifang Medical College from September 2,2022,to August 18,2023 were selected and randomly divided into groups A,B,and C according to the random number table method,with 40cases in each group.Group A was the control group,which was anesthetized by sevoflurane.Group B was the alfentanil group,which was anesthetized by fentanyl combined with sevoflurane.Group C was anesthetized by alfentanil combined with dexmedetomidine and sevoflurane.The main outcome measures were pediatric anesthesia emergence delirium(PAED)score and pediatric agitation rate immediately after extubate(E0),5min after extubate(E5)and10min after extubate(E10).Secondary outcome indicators included spontaneous respiratory recovery time,postoperative extubate time,PACU residence time,FLACC Pain Assessment Scale score(FLACC Pain Assessment Scale),the addition of analgesics,and the incidence of adverse reactions.Results At three different time points,E0,E5,and E10,PAED scores were significantly lower in group B(9.6±2.2,6.6±2.0,and 5.0±1.8points)and group C(9.0±1.6,6.2±1.5,and4.9±1.2points)compared with those of group A(11.8±2.2,9.3±2.2,and 7.3±1.9points),with a statistically significant difference,P<0.05;The incidence of postoperative agitation was significantly lower in both Group B(10%)and Group C(5%)compared with Group A(30%),with a statistically significant difference,χ^(2)=10.980,P<0.05.The postoperative recovery time of spontaneous breathing(15.1±2.3)min,extubation time(17.8±2.6)min,and PACU stay(48.2±5.7)min in group C were significantly prolonged compared with the postoperative recovery time of spontaneous breathing(9.0±1.7)min,extubation time(10.8±1.9)min,and PACU stay(39.4±5.8)min in group A,the differences were statistically significant,P<0.05;FLACC scores of group B(2.4±1.0)points and group C(2.0±0.8)points were significantly lower compared with those of group A(4.7±1.3)points,and the number of cases of children who were given additional alfentanil and the incidence of coughing were significantly reduced,with a statistically significant difference,P<0.05;The incidence of somnolence was significantly higher in group C(21%)compared to groups A(10%)and B(13%),with a statistically significant difference,χ^(2)=6.962,P<0.05.Conclusion Alfentanil used in sevoflurane general anesthesia pediatric tonsillectomy can effectively improve the quality of anesthesia recovery and reduce the occurrence of postoperative agitation,which is worthy of clinical application and promotion.