骶管阻滞对小儿七氟烷全麻苏醒期躁动的影响

目的：观察骶管阻滞对小儿七氟烷全麻苏醒期躁动的影响。方法选择我院2015年7~10月择期行腹腔镜疝囊高位结扎术小儿60例，年龄2~5岁，ASAⅠ或Ⅱ级，采用随机数字表法随机分为骶管阻滞组(D组)和对照组(C组)，每组30例。D组先行骶管阻滞0.2%罗哌卡因1.2 mL/kg，余下操作同C组：麻醉诱导置入喉罩，术中麻醉维持七氟烷复合瑞芬太尼，术毕苏醒拔除喉罩，送入麻醉后监测治疗室(PACU)。苏醒期躁动采用儿童麻醉苏醒期躁动评分(PAED)。记录入PACU即刻、5 min、15 min、30 min的PAED评分；记录术后30 min、2 h、6 h、12 h、24 h疼痛评分，按照加拿大东安大略儿童医院疼痛评分(CHEOPS)标准。结果与入PACU即刻比较，C组在入PACU后30 min时的PAED评分明显下降[(3.20±2.23)分vs (9.43±2.24)分，P<0.01]，而D组各时点的PAED评分差异无统计学意义(P>0.05)；与C组比较，D组在入PACU即刻[(3.20±1.30)分vs (9.43±2.24)分]、5 min [(3.50±1.14)分vs (9.73±2.20)分]、15 min [(3.43±1.04)分vs (9.13±2.36)分]的PAED评分均明显降低(P<0.01)，C组与D组PAED评分大于10分的例数分别为10例、0例(P<0.01)；D组术后30 min、2 h、6 h、12 h的疼痛评分(CHEOPS评分)均明显低于C组(P<0.01)。结论骶管阻滞复合七氟烷全麻用于小儿腹腔镜疝囊高位结扎术，可减少苏醒期躁动，减轻术后疼痛。

Effect of sacral anesthesia on emergence agitation after sevoflurane anesthesia in children

Objective To observe the effect of sacral block on emergence agitation after sevoflurane anesthesia in children. Methods A total of 60 children aged 2~5 years, ASAⅠorⅡ, undergoing elective laparoscopic high liga-tion of inguinal hernial sac from July 2015 to October 2015 were randomly divided into 2 groups: sacral block group (group D) and control group (group C), with n=30 in each group. Group D first applied sacral canal block with 0.2%rop-ivacaine 1.2 mL/kg, and the remaining operation was the same as that of group C. Laryngeal mask was inserted under in-duction of anesthesia. Anesthesia was maintained with sevoflurane-remifentanil. Laryngeal mask was removed after re-covery from anesthesia, and the patients were then sent into the postanesthesia care unit (PACU). Emergence agitation was evaluated by the Pediatric Anesthesia Emergence Delirium scale (PAED), and the PAED scores were recorded at 0 min, 5 min, 15 min, 30 min after entering PACU. The pain scores were recorded at 30 minutes, 2 h, 6 h, 12 h, 24 h after sur-gery, according to the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). Results Compared with the PAED score at 0 minutes after entering PACU, it significantly decreased at 30 minutes after entering PACU in group C [(3.20±2.23) vs (9.43±2.24), P<0.01], while the PAED scores in group D showed no significant difference at each time point (P>0.05). Compared with group C, PAED scores of group D were decreased at 0 min [(3.20 ± 1.30) vs (9.43 ± 2.24)], 5 min [(3.50±1.14) vs (9.73±2.20)], 15 min [(3.43±1.04) vs (9.13±2.36)] after entering PACU (P<0.01). The pa-tients' cases of the PAED score greater than 10 points were respectively 10 and 0 cases in group C and group D (P<0.01). Compared with group C, CHEOPS scores of group D were decreased at 30 minutes, and 2 h, 6 h, 12 h after sur-gery (P<0.01). Conclusion Sacral block combined with sevoflurane general anesthesia has advantages of reducing emergence agitation and relieving postoperative pain in children undergoing laparoscopic hernia sac high ligation.