低阿片药物麻醉对小儿腹腔镜疝修补术苏醒期躁动的影响

Effect of opioid-sparing anesthesia on emergence agitation after laparoscopic hernia repair in children Geng Pengcheng

目的探讨低阿片药物麻醉对小儿腹腔镜疝修补术苏醒期躁动(EA)发生情况的影响。方法采用单中心随机对照的研究设计方案,纳入美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级、年龄6~36个月行择期腹腔镜下疝修补术的患儿82例,采用随机数字表法分为两组(每组41例):常规组(C组)和低阿片组(DS组)。两组患儿均使用七氟醚吸入诱导,麻醉镇痛方案C组采用舒芬太尼(0.3μg/kg),DS组采用艾司氯胺酮(1 mg/kg)联合右美托咪定(0.5μg/kg)。喉罩拔除后30 min内采用小儿麻醉后苏醒期谵妄量表(PAED)每5 min评估1次EA发生情况,并记录最高PAED评分;记录入室(T_(0))、插入喉罩前(T_(1))、插入喉罩后5 min(T_(2))、切皮后5 min(T_(3))、术毕(T_(4))时的平均动脉压(MAP)及心率;拔管后30 min内采用FLACC评分每5 min评估1次疼痛情况,记录最高FLACC评分;记录补救镇痛情况、手术时间、苏醒时间、麻醉后监测治疗室(PACU)停留时间及PACU复苏期间恶心呕吐、低氧血症、喉痉挛等不良反应发生情况。结果与C组比较,DS组EA发生率、最高PAED评分、最高FLACC评分较低(均P<0.05)。两组补救镇痛率、手术时间、拔管时间、PACU停留时间及不良反应发生率差异无统计学意义(均P>0.05)。两组心率的时间效应差异有统计学意义(P<0.05),时间与组别交互效应差异无统计学意义(P>0.05);MAP的时间效应差异有统计学意义(P<0.05),时间与组别的交互效应差异有统计学意义(P<0.05)。两组各时点心率和MAP比较,差异无统计学意义(均P>0.05)。结论低阿片药物麻醉方案在婴幼儿腹腔镜疝修补术中能够降低患儿EA的发生率和术后疼痛评分,不增加围手术期并发症。

ObjectiveTo investigate the effect of opioid-sparing anesthesia on emergence agitation(EA)in children undergoing laparoscopic hernia repair.MethodsA single-center randomized controlled trial was conducted.A total of 82 children,American Society of Anesthesiologists(ASA)ⅠorⅡ,aged 6 to 36 months,who underwent elective laparoscopic hernia repair were selected.According to the random number table method,they were divided into two groups(n=41):a conventional group(group C)and an opioid-sparing group(group DS).Both groups underwent anesthesia induction with sevoflurane.Group C received sufentanil(0.3μg/kg),and group DS received esketamine(1 mg/kg)combined with dexmedetomidine(0.5μg/kg).Within 30 min after laryngeal mask removal,the incidence of EA was assessed with the Pediatric Anesthesia Emergence Delirium(PAED)scale every 5 min,and the highest PAED score was recorded.The mean arterial pressure(MAP)and heart rate were recorded at admission to the operating room(T_(0)),before insertion of laryngeal mask(T_(1)),5 min after insertion of laryngeal mask(T_(2)),5 min after incision(T_(3)),and at the end of operation(T_(4)).Pain was assessed by the Face,Legs,Activity,Cry,Consolability(FLACC)scale every 5 min for 30 min after extubation,and the highest FLACC score was recorded.The use of rescue analgesia,the duration of operation,emergence time,the length of post-anesthesia care unit(PACU)stay,and the incidences of adverse reactions,such as nausea and vomiting,hypoxemia,and laryngeal spasms during the recovery period in the PACU were recorded.The use of remedial analgesia,operation time,recovery time,PACU residence time and the occurrence of adverse reactions such as nausea and vomiting,hypoxemia and laryngeal spasm during PACU resuscitation were recorded.ResultsCompared with group C,group DS showed decreases in the incidence of EA,the highest PAED score and the highest FLACC score(all P<0.05).There were no statistical differences in the rate of rescue analgesia,the duration of operation,time to extubation,the length of PACU stay and the incidence of adverse reactions between the two groups(all P>0.05).The difference of time effect of heart rate between two groups was statistically significant(P<0.05),but the difference of time and group interaction effect was not statistically significant(P>0.05).The difference of time effect of MAP between two groups was statistically significant(P<0.05),and the difference of time and group interaction effect was statistically significant(P<0.05).There was no statistical difference in heart rate and MAP between the two groups at each time point(all P>0.05).ConclusionsThe opioid-sparing anesthesia strategy reduces the incidence of EA and postoperative pain score in children undergoing laparoscopic hernia repair,without increases in perioperative complications.