不同麻醉方法对扁桃体切除术后患儿躁动的影响

摘要

Objective To compare the postoperative restlessness effect of three anesthesia methods in children with tonsillectomy.Methods Sixty cases of 6-10 years old and American Society of Anesthesiology I grade children with tonsillectomy were divided into three groups( n =20).All of them had tracheal cannula and controlled the respiration with breathing machine after quickly anesthesia induction with lidocaine,fentanyl,vecuronium bromide and propofol.In group M:venous pumped fentanyl combined with propefol and breathe in sevoflurance to keep anesthesia; group R:breathed in sevoflurance to keep anesthesia simple; group V:venous pumped fentanyl combined with propofol to keep anesthesia.Drug discontinuanced afteroperation,and we observed the anesthesia time,intraoperation mean artery pressure( MAP),the change of heart rate and the palinesthesia time afteroperation.We recorded the status with restlessness score in the stage of analepsia.Results The anesthesia time,intraoperation MAP and the change of HR had no difference in three groups ( P ＞ 0.05 ).The palinesthesia time was shorter in group R than that in group M and V[(7.5 ±3.2)min vs( 11.8 ±5.6)min,(10.3 ±4.7)min,P ＜0.05],but the afteroperation restlessness incidence rate was higher in group R than that in group M and V[(4.1 ±0.5) scores vs (3.1 ±0.5)scores,(3.0 ±0.6)scores],and more cases needed drugs to intervention[6 cases(30％ ) vs 2 cases ( 10％ ),2 cases( 10％ )]( P ＜0.0l ).The palinesthesia time and postoperative restlessness had no difference between group M and V.Conclusion The postoperativerestlessness incidence rate is low with intravenous anesthesia or combined with breath in to keep anesthesia of children having tonsillectomy.%目的 比较不同麻醉方法对择期行扁桃体切除术患儿术后躁动的影响.方法 择期行扁桃体切除术的患儿60例,年龄6～10岁,ASA Ⅰ级,完全随机分为3组,各20例,即静脉泵注丙泊酚加芬太尼并吸入七氟醚维持麻醉组(M组)、单纯吸入七氟醚维持麻醉组(R组)和静脉泵注丙泊酚加芬太尼维持麻醉组(V组).手术结束时停药,观察麻醉时间、术中平均动脉压、HR的变化、术毕苏醒时间,采用躁动评分记录苏醒期的躁动情况.结果 3组的麻醉时间、术中平均动脉压、HR的变化无差异(P＞0.05)；R组比M、V组苏醒时间缩短[(7.5±3.2)min比(11.8±5.6) min、(10.3±4.7)min,P＜0.05],但术后躁动评分明显比M、V组高[(4.1±0.5)分比(3.1±0.5)分、(3.0±0.6)分]且需药物干预例数多[6例(30％)比2例(10％)、2例(10％)](P＜0.01),而M、V组的苏醒时间和术后躁动差异无统计学意义(P＞0.05).结论 儿童行扁桃体切除术采用静吸复合麻醉或静脉麻醉维持比单纯吸入麻醉维持的术后躁动发生率低,单纯吸入七氟醚维持麻醉不可取.