氢吗啡酮在小儿眼科日间手术全麻中的应用

摘要

ObjectiveTo investigate the effect of Hydromophone on children undergoing inhalation anesthesia, during ophthalmologic day case surgery.Method60 children who were undergoing ophthalmologic operation, aged 3~7 year, ASAⅠ~Ⅱ, and not received any premedication were selected. They were randomly divided into two groups: C (congtrol group) and H(Hydromophone group). After 7% sevoflurane inhalation anesthetic induction and placement of the intravenous line, the laryngeal airway was inserted, the patient was left in spontaneous ventilation, recorded BIS, HR, Vt, RR, MV, PETCO2, PETsev of the time and marked as T1. During the procedure, 0.01mg/kg Hydromophone was given by intravenous pump in 10 minutes in H group, while equal normal saline was given in C group. Ten minutes later when the operation start, recorded the data such as BIS, HR, VT, RR, MV, PETCO2of each group, marked as T2.At the end of the surgery, marked the time T3, recorded the data as those of T1 again, and removed the laryngeal airway, took the patient to the PACU.ResultThere were no differences between the data of the two groups of T1 and T3. While at the time T2, the RR, BIS and MV, HR of H group was 34.60%, 27.21%, 12.10%, 8.02% lower than C group, the PETCO2 of H group was 12.16% higher than C group,and there were significant differences between them (P<0.05). The Vt of H group was 3.15% lower than C group, although there was no significant difference between them (P<0.05). The most important result was that 23.33% children in C group complained for postopration pain, visual analogue scale>3, and needed some necessary treatments,and delayed the time of leaving PACU and hospital, however there was no significant difference between the two groups, while none in H group. And no nause or drowsiness child after surgery in each group. ConclusionA dose of 0.01mg/kg Hydromophone after induction can afford satisfying analgesia during the ophthalmologic day case surgery, even without untowards effects and obvious respiratory depression, decrease the concern about disposition, but we should pay attention to PETCO2, during the fastigium of Hydromophone.%目的：观察氢吗啡酮在小儿眼科日间手术全麻中的应用。方法选择2015年3月1日至12月31日间本院择期行眼科日间手术的患儿60例，年龄3～7岁。随机分为两组：对照组（C组），氢吗啡酮组（H组）。两组均采用潮气量法以7%七氟烷吸入诱导后置入喉罩，术中保留自主呼吸，开放静脉后，H组静脉给予0.01mg/kg氢吗啡酮，C组给予相应剂量生理盐水，两组药物均稀释至10ml，10分钟静脉泵入。分别记录诱导后给药前（T1），给药10分钟后手术开始时（T2），手术结束时（T3）的脑电双频指数（bispectral index，BIS）、心率（heart rate，HR）、潮气量（tidalvolume，VT）、呼吸频率（respiration rate，RR）、分钟通气量（minute ventilation，MV）、呼气末二氧化碳分压（pressure of carbon dioxide in expired tidal，PETCO2），并进行比较。结果两组T1、T3时点的BIS、HR、RR、MV、PETCO2比较差异无显著性（P＞0.05）。T2时点H组与C组比较RR低34.60%，MV低27.21%，PETCO2高12.16%，HR低8.02%，BIS低12.10%，且两组差异均有显著性（P＜0.05）；H组VT比C组低3.15%，但两组比较差异无显著性（P＞0.05），两组均能保留自主呼吸。H组有1例术后有头晕，但所有患儿术后视觉模拟评分＜3分；C组有7例患儿术后视觉模拟评分＞3分，从而出现不同程度术后不安甚至躁动，需要给予药物处理，延长麻醉后恢复室观察时间及离院时间，但两组患儿出麻醉后恢复室时间的差异比较无显著性（P＞0.05）。结论0.01mg/kg氢吗啡酮可以满足小儿眼科手术围术期镇痛，并不出现严重的呼吸抑制，无苏醒延迟，日间手术中应用可以减少疼痛及不良反应，可按时安全离院。但给药后药物高峰期需要密切监测，警惕二氧化碳蓄积。