瑞马唑仑预防儿童七氟烷全麻术后躁动的效果观察

Observation on the effect of remimazolam in preventing agitation after sevoflurane general anesthesia in children

目的探讨瑞马唑仑预防儿童七氟烷全麻术后躁动的效果。方法选取2023年4—10月因腺样体肥大就诊于首都医科大学附属北京同仁医院并行鼻内镜下腺样体切除术的患儿60例,按随机数字表法分为七氟烷组(S组)和瑞马唑仑+七氟烷组(RS组),每组30例。两组患儿麻醉维持均采用吸入七氟烷复合静注瑞芬太尼,RS组患者在手术结束前10 min静脉注射0.1 mg/kg瑞马唑仑。比较两组一般情况、手术情况、躁动发生情况、不同时期谵妄评分、家长满意度等。结果60例患儿中男33例、女27例;年龄5.0(2.5,6.0)岁。与S组相比,RS组睁眼时间较长[17.0(14.2,23.9)min比13.5(9.4,16.5)min]、拔管时间较长[19.0(16.7,24.6)min比15.0(11.5,19.4)min]、麻醉后恢复室(postanesthesia care unit,PACU)停留时间较长[39.0(35.2,47.6)min比35.0(29.3,39.4)min],苏醒期躁动发生率较低(16.6%比43.3%);不同时间患儿麻醉苏醒期谵妄(pediatric anesthesia emergence delirium,PAED)评分均较低;家长满意度评分较高[(8.3±1.1)分比(6.9±0.6)分],差异均有统计学意义(P<0.05)。结论术中静脉注射0.1 mg/kg的瑞马唑仑可降低患儿在七氟烷麻醉后苏醒期躁动的发生率,有效提高患儿家长满意度。

Objective To explore the effect of remimazolam in preventing agitation after sevoflurane general anesthesia in children.Methods A total of 60 patients underwent nasal endoscopic adenoidectomy due to adenoid hyperemia in Beijing Tongren Hospital,Capital Medical University from April to October 2023 were selected,and were divided into sevoflurane group(group S)and remimazolam+sevoflurane group(group RS)according to the random number table method,with 30 patients in each group.Both groups were given inhalation of sevoflurane combined with intravenous injection of remifentanil,while patients in group RS were given 0.1 mg/kg remimazolam intravenously 10 min before the end of surgery.The general condition,operation,agitation,delirium score in different periods and parents'satisfaction were compared between the two groups.Results Among the 60 children,there were 33 males and 27 females,the average age was 5.0(2.5,6.0)years.Compared with group S,the time of opening eyes was longer[17.0(14.2,23.9)min vs.13.5(9.4,16.5)min],the extubation time was longer[19.0(16.7,24.6)min vs.15.0(11.5,19.4)min]and the stay time in postanesthesia care unit(PACU)was longer[39.0(35.2,47.6)min vs.35.0(29.3,39.4)min],while the incidence of pre-awakening agitation was lower(16.6%vs.43.3%),the scores of pediatric anesthesia emergence delirium(PAED)at different times were lower,and the scores of parens'satisfaction was higher[(8.3±1.1)points vs.(6.9±0.6)points]in the RS group,and the differences were statistically significant(all P<0.05).Conclusions Intravenous injection of 0.1 mg/kg remimazolam can significantly reduce the incidence of agitation and effectively improve the satisfaction of parents in children during the recovery period after sevoflurane anesthesia.