术前静滴酮咯酸氨丁三醇预防小儿全麻苏醒期躁动的临床观察

目的观察预先静脉滴注酮咯酸氨丁三醇对小儿全麻苏醒期躁动的影响。方法选择60例择期静吸复合全麻下行骨折内固定物取出术患儿,随机分为试验组和对照组,每组30例。全麻诱导前10 min试验组静脉滴注酮咯酸氨丁三醇0.5 mg/kg,对照组静脉滴注相同容量的生理盐水。记录两组患儿手术时间、麻醉时间、拔除喉罩时间、苏醒室停留时间,患者在入室及拔除喉罩时(T1)、到达苏醒室后5 min(T2)、15 min(T3)、30 min(T4)各时点的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)值以及T1～T4的疼痛、躁动和镇静评分(分别为FLACC评分、PAED评分和Ramsay评分),并观察恶心呕吐、低氧血症、呼吸抑制、反流误吸、瘙痒等不良反应发生情况。结果试验组在T1、T2、T3时点HR低于对照组,在T1、T2时点MAP低于对照组;试验组的疼痛评分在T1、T2、T3时点均低于对照组,躁动评分在4个时点均低于对照组,镇静评分在T1、T2、T3时点均高于对照组,差异有统计学意义(P<0.05)。结论在骨折内固定物取出术患儿全麻诱导前预先静脉滴注酮咯酸氨丁三醇0.5 mg/kg,可获得良好的镇痛效果,减少苏醒期躁动,无明显不良反应的发生。

Preventive effect of ketorolac tromethamine on emergence agitation in children

Objective To evaluate the preventive effect of ketorolac tromethamine on emergence agitation in children. Methods Sixty children undergoing selective removal of fracture fixation were randomly divided into treat- ment group （ n = 30） in which ketorolac tromethamine 0. 5 mg/kg was given and control group （ n = 30） in which the same volume of physiological saline was given, 10 minutes before induction. Duration of surgery and anesthesia, laryn- geal mask removing time and PACU staying time were recorded. HR, MAP and SpO2 were recorded at the time arriving at operating room and the time laryngeal mask was removed （ T1 ） and 5 minutes （T2） , 15 minutes （ T3 ） and 30 mi- nutes （T4） after arriving at PACU. Pain, agitation and sedation scores were recorded at T1 to T4. Adverse reactions as nausea and vomiting, hypoxemia, respiratory depression, regurgitation and aspiration, itching were recorded. Results HR and MAP in the treatment group were lower than those of the control group at T1 to T3, pain scores in the treatment group were lower than those in the control group at T1, T2, T3, agitation scores were lower than those in the control group at all four time points, sedation scores were higher than those in the control group at T1, T2, T3, the differences were significant （ P 〈 0. 05 ）. Conclusion 0. 5 mg/kg of ketorolac tromethamine before induction of anesthesia decrea- ses the emergence agitation in children without more adverse reactions.