丙泊酚和七氟烷对小儿骨科手术苏醒期躁动的影响

Effect of propofol and sevoflurane anesthesia on emergence agitation in children with orthopedic surgery

目的观察丙泊酚和七氟烷在神经阻滞复合喉罩全身麻醉的小儿骨科手术中,对小儿术后苏醒期躁动的影响。方法选择本院小儿骨科手术患儿80例,随机分成丙泊酚组和七氟烷组。患儿采用改良耶鲁术前焦虑量表(the modified Yale Preoperative Anxiety Scale,m-YPAS)评估后入手术室,常规静脉诱导后置入喉罩机械通气,采用不同的麻醉药物进行维持,随后局麻下行超声引导神经阻滞。所有患儿在恢复自主呼吸后氧饱和度均维持在95%以上,拔除喉罩送至苏醒室。观察比较两组患儿苏醒时的拔管时间、小儿麻醉苏醒期躁动量化评分表(pediatric anesthesia emergence delirium scale,PAED)评分及儿童疼痛行为量表(The face,legs,activity,cry,consolability behavioral tool,FLACC)评分和Richmond躁动-镇静量表(Richmond agitation and sedation scale,RASS)评分。结果丙泊酚组和七氟烷组患儿的m-YPAS评分分别为(26.94±11.07)分、(26.10±8.22)分,差异无统计学意义(P=0.699)。丙泊酚组拔管时间明显长于七氟烷组[(9.95±5.27)min vs.(5.30±2.94)min],急性躁动PAED评分明显低于七氟烷组[(7.15±2.30)分vs.(9.50±2.44)分],苏醒期躁动发生率明显低于七氟烷组(5%vs.15%),上述指标比较,差异均有统计学意义(P均<0.001)。躁动患儿的FLACC评分为3～8分,RASS评分为-3～-2分,处于轻度至中度镇静状态。结论小儿骨科手术神经阻滞复合喉罩全身麻醉术后苏醒躁动仍有发生;丙泊酚维持麻醉术后躁动发生率较七氟烷低,患儿舒适安全,值得临床推广。

Objective To conduct a randomized - controlled trial comparing the incidence of emergence agitation(EA) in children following propofol and sevoflurane anesthesia, who accepted orthopedic surgery under nerve block anesthesia and general anesthesia with laryngeal mask.Methods Eighty pediatric patients in our hospital were enrolled in a blinded randomized-controlled trial of propofol anesthesia group versus sevoflurane anesthesia group. The modified Yale Preoperative Anxiety Scale(m-YPAS) was used to evaluate the anxiety of children before operation. After intravenous induction, laryngeal mask airway was used for mechanical ventilation, and different anesthesia drugs were used for maintenance, and then ultrasound-guided nerve block was given. All the children recovered their spontaneous breathing to maintain oxygen saturation above 95%, and the laryngeal mask was pulled out. The time of extubation, pediatric anesthesia emergence delirium scale(PAED), and the face, legs, activity, cry, consolability behavioral tool(FLACC) scores and Richmond agitation and sedation scale(RASS) were compared.Results There was no significant difference in the m-YPAS scores(propofol vs. sevoflurane: 26.94±11.07 vs. 26.10±8.22, P=0.699). Incidence of EA was lower in propofol anesthesia group(5%, 2 from 40 children) than in sevoflurane anesthesia group(15%,6 from 40 children). The PAED scores in propofol anesthesia group were significantly lower than in sevofluane anesthesia group(7.15±2.30 vs. 9.50±2.44, P<0.001). The time of extubation in propofol anesthesia group was significantly longer than in sevofluane anesthesia group(9.95±5.27 vs. 5.30±2.94, P<0.001). Children with restlessness had a FLACC score of 3-8, a RASS score of-3 to-2, and were in mild to moderate sedation.Conclusion EA still occurs after nerve block in pediatric orthopedic surgery under general anesthesia. The incidence of EA after propofol anesthesia is lower than that after sevoflurane anesthesia. This anesthesia method following propofol is comfortable and safe for children, and is worthy for clinical promotion.