七氟醚复合瑞芬太尼对小儿扁桃体切除术后苏醒期躁动及血流动力学的影响

目的研究七氟醚复合瑞芬太尼对小儿扁桃体切除术后苏醒期躁动(EA)及血流动力学指标的影响。方法选择2016年5月至2020年6月在宁波市第一医院接受扁桃体切除手术的患儿78例作为研究对象,根据使用的麻醉方法不同分为对照组(七氟醚)41例和复合组(七氟醚复合瑞芬太尼)37例,观察并比较两组患儿麻醉相关指标、EA和不良反应发生率,并比较不同时间点麻醉诱导前(T0)、气管插管前即刻(T1)、气管插管后3min(T2)、术后即刻(T3)、拔管即刻(T4)、拔管1min(T5)、拔管5min(T6)以及拔管10min(T7)]患儿的血流动力学指标和疼痛程度。结果复合组EA评分在T4~T7各时刻均显著低于对照组(t值分别为2.441、5.439、7.149、6.598,均P<0.05),两组患儿在T4~T7时刻EA评分的下降趋势差异有统计学意义(F_组间=86.912,F_时间=81.711,均P<0.05);复合组心率(HR)、平均动脉压(MAP)水平在T3~T7各时刻均显著低于对照组(t值为2.190~5.057,均P<0.05),两组患儿在T3~T7时刻HR、MAP水平的下降趋势差异有统计学意义(F_组间分别为55.486、26.439,F_时间分别为76.367、12.173,均P<0.05);复合组疼痛评分在T4~T7各时刻均显著低于对照组(t值分别为3.656、3.016、3.327、3.230,均P<0.05),两组患儿在T4~T7时刻疼痛评分的下降趋势差异有统计学意义(F_组间=43.312,F_时间=71.114,均P<0.05);两组不良反应发生率对比无显著差异(P>0.05)。结论七氟醚复合瑞芬太尼应用于小儿扁桃体切除术的麻醉安全有效,可减少患儿术后EA,维持血流动力学稳定,减轻疼痛。

Influence of sevoflurane combined with remifentanil anesthesia on emergence agitation and hemodynamics of children following tonsillectomy

Objective To investigate influence of sevoflurane combined with remifentanil anesthesia on emergence agitation(EA)and hemodynamics of children after tonsillectomy.Methods From May 2016 to June 2020,78 children who underwent tonsillectomy in the First Ningbo Muncipal Hospital were selected as study subjects.The children who were given sevoflurane anesthesia were divided into control group(41 cases),while those children who were given sevoflurane combined with remifentanil anesthesia were included in the combined anesthesia group(37 cases).Anesthesia-related indexes,the incidences of EA and adverse reactions,hemodynamic indexes and pain degree at different time pointsbefore induction of anesthesia(T0),immediately before intubation(T1),3 min after intubation(T2),immediately after operation(T3),immediately after extubation(T4),1 min after extubation(T5),5 min after extubation(T6)and 10 min after extubation(T7)]were compared between the two groups.Results The EA scores of the children in the combined anesthesia group were significantly lower than those in the control group at T4~T7(t=2.441,5.439,7.149 and 6.598 respectively,all P<0.05),and the differences in the decreasing trend of EA score at T4~T7 between the two groups were statistically significant(F_(between groups)=86.912,F_time=81.711,both P<0.05).Heart rate(HR)and mean arterial pressure(MAP)of the patients in the combined anesthesia group were significantly lower than those in the control group at T3~T7(t=2.190~5.057,all P<0.05),and the differences in the decreasing trends in HR and MAP at T3~T7 between the two groups were statistically significant(F_(between groups)=55.486 and 26.439 respectively,F_time=76.367 and 12.173 respectively,all P<0.05).The pain scores at T4~T7 time points of the children in the combined anesthesia group were significantly lower than those of the children in the control group(t=3.656,3.016,3.327 and 3.230 respectively,all P<0.05),and there were statistically significant differences in the decreasing trend in pain scores at T4~T7 time points between the two groups(F_(between groups)=43.312,F_time=71.114,both P<0.05).There was no significant difference in incidence of adverse drug reactions(ADR)between the two groups(P>0.05).Conclusion Sevoflurane combined with remifentanil is a safe and effective anesthesia method for the children undergoing tonsillectomy,which can effectively reduce incidence of postoperative EA,maintain hemodynamic stability and relieve pains of the children.