曲马多联合水合氯醛对小儿全身麻醉苏醒期躁动的影响

摘要

目的：研究曲马多联合水合氯醛预防小儿全身麻醉（简称全麻）苏醒期躁动的临床疗效。方法选择拟行全麻术治疗的患儿135例，按苏醒期躁动的预防方式将其分为联合用药组、单药组、对照组，各45例。对照组患儿苏醒期躁动未予临床干预，单药组患儿手术结束前应用曲马多干预，联合用药组患儿在单药组基础上加用水合氯醛保留灌肠。结果与对照组比较，联合用药组、单药组麻醉前、停药时平均动脉压(MAP）、心率(HR）水平差异无统计学意义（P＞0．05），麻醉清醒时、拔管时均有明显差异（P＜0．05）；与单药组比较，联合用药组麻醉前、停药时的MAP及HR水平差异无统计意义（P＞0．05），麻醉清醒时、拔管时均有明显差异（P＜0．05）；联合用药组、单药组麻醉前、停药时、清醒时、拔管时各时点疼痛评分(CHIPPS )与对照组比较，均有明显差异（P＜0．05），联合用药组CHIPPS评分与单药组比较，也有明显差异（P＜0．05）；联合用药组、单药组麻醉前、停药时、清醒时、拔管时各时点躁动评分(PAED)与对照组比较，也呈明显差异（P＜0．05），联合用药组各时点PAED评分与单药组比较，也呈明显差异（P＜0．05）；联合用药组、单药组患儿麻醉时间、手术时间、清醒时间、拔管时间与对照组比较，均无明显差异（P＞0．05），联合用药组患儿麻醉、手术、清醒、拔管时间与单药组比较，差异无统计学意义（P＞0．05）。结论曲马多联合水合氯醛预防小儿全麻苏醒期躁动，不仅对麻醉清醒时、拔管时的MAP及HR水平具有积极作用，且能改善麻醉前、停药时、清醒时、拔管时CHIPPS评分、PAED评分水平，不影响治疗阶段的麻醉、手术、清醒及拔管时间，疗效显著，值得临床推广。%Objective To study the clinical efficacy of tramadol combined with chloral hydrate for the prevention of agitation in the re-vival period of full anesthesia in children.Methods 135 cases of clinical data were divided into the combined drug group,single drug group and control group according to the agitation prevention methods,45 cases in each group.The control group was given no clinical intervention,the single drug group was given tramadol at the end of surgery,the combined drug group was given chloral hydrate on the basis of the single drug group.Results Compared with the control group,the MAP and HR in the single drug group and combined treatment group before anesthesia and stopping medication,had no statistical difference(P >0.05),while the awakening and extubation time showed a significant difference(P 0.05);the anesthesia,stopping medication,awakening,and extubation time of the combined medication group had no significant difference with the single drug group (P >0.05).Conclusion Tramadol combined with chloral hydrate in preventing agitation in the revival period of full anesthesia in children can not only have a positive effect on anesthesia,stopping medication,awakening,and extubation time,but also the CHIPPS scores and PAED scores,and is worthy of clinical promotion.