舒芬太尼和曲马多预处理对小儿苏醒期躁动影响的比较

目的:比较舒芬太尼、曲马多预处理对小儿腺样体+扁桃体摘除手术全身麻醉苏醒期躁动(EA)的影响。方法:3~7岁行腺样体+扁桃体摘除手术小儿54例,随机分为3组:对照组(C组)、舒芬太尼组(S组)、曲马多组(T组),分别在手术结束前5 min静脉注射生理盐水5 ml、舒芬太尼0.1μg/kg、曲马多1 mg/kg,观察记录各组患儿在注药前(T1)、术后5 min(T2)、拔管前(T3)、拔管后10 min(T4)时的心率(HR)、平均动脉压(MAP);记录患儿手术时间(Ts)、苏醒时间(Ta);使用小儿麻醉苏醒期躁动量表(PAED)对苏醒时小儿进行躁动评分。结果:T2时3组的HR、MAP比T1时有不同程度降低;与T1时比较,T3、T4时3组的HR、MAP升高(P<0.05)。T3、T4时S组、T组的HR、MAP较C组降低(P<0.05);与C组比较,S组、T组的Ta延长,PAED评分和躁动发生率降低(P<0.05)。结论:舒芬太尼或曲马多预处理都可以降低小儿腺样体+扁桃体摘除手术全身麻醉拔管时的心血管反应,减少苏醒期躁动,但可致苏醒时间延长。

Comparison of the effects of pretreatment with sufentanil and tramadol on emergence agitation after general anesthesia in children

Objective To compare the effects of pretreatment with sufentani] and tramadol on emergence agitation after general anesthe- sia in children undergoing tonsillectomy and adenotonsillectomy. Method Fifty - four healthy children, aged 3 - 7 years old, scheduled for tonsillectomy and adenotonsillectomy surgery were enrolled. These patients were randomly divided to three group （ n = 18） ：control group （group C）, sufentanil group （group S） and tramadol group （group T） , which received intravenously saline 5 ml, sufentanil 0. 1 μg/kg and tramadol 1 mg/kg 5 minutes before the end of surgery respectively. HR and MAP were recorded before injection （ TI ） ,5 minutes after sur- gery （T2 ）, before extubation （T3 ）, 10 minutes after extubation （T4 ）. The duration of surgery （Ts） and time for awakening （Ta） were re- oorded too. Emergence agitation was evaluated by the pediatric anesthesia emergenee delirium scale （PAED）. Results HR and MAP in each group at T2 decreased to varying degree than at T1 ; Compared to at T1 , HR and MAP at T3 and T4 increased （ P 〈 0. 05 ）. HR and MAP at T3 and T4 in group S and group T decreased than group C （P〈 0.05） ;Compared to group C,Ta extended in group S and group T,thc score of PAED and the incidence of emergence agitation lowered in group S and group T（P 〈0. 05）. Conclusion Pretreatment with sufentanil or tramadol ean lower the cardiovascular responses during cxtubation, and decrease incidence of emergence agitation after general anesthesia in children undergoing tonsillectomy and adenotonsillcctomy, but it can extend the time for awakening.