目的 观察不同剂量地佐辛对腹腔镜斜疝修补术患儿全麻苏醒期躁动(EA)的影响.方法 选择在丙泊酚复合瑞芬太尼全麻下行腹腔镜斜疝修补术的患儿120例,按随机数字表法分为4组,每组30例.手术结束前15 min,C组(对照组)静脉注射生理盐水2 ml,D1、D2、D3组分别静脉注射0.10 mg/kg、0.15 mg/kg、0.20 mg/kg地佐辛.记录4组患儿拔除气管导管时间、麻醉后监测治疗室(PACU)停留时间及EA发生率,记录4组患儿拔管即刻、拔管后10 min及30 min患儿麻醉苏醒期躁动量化评分(PAED)及拔管后10 min镇静(Ramsay)评分,观察4组患儿术后6 h不良反应发生情况.结果 D3组拔除气管时间、PACU停留时间及恶心、呕吐发生率均长于或高于其他3组(均P<0.05),而C组、D1组、D2组间差异均无统计学意义(均P>0.05);D2组、D3组EA发生率均低于C组及D1组(均P<0.05),而D2组与D3组间及C组与D1组EA间差异均无统计学意义(均P>0.05).拔管后30 min 4组PAED评分比较,差异无统计学意义(P>0.05),拔管即刻、拔管10 min D2组、D3组PAED评分均低于C组及D1组(均P<0.05),而D2组与D3组间及C组与D1组间均无统计学意义(均P>0.05).术后10 min Ramsay评分D3组高于C组、D1组和D2组,D2组高于C组(均P<0.05),而D2、D1组间及C组、D1组间差异均无统计学意义(均P>0.05).结论 手术结束前15 min静注地佐辛0.15 mg/kg能明显降低腹腔镜斜疝修补术患儿全麻EA的发生率,且不延长拔管时间及PACU停留时间,副作用少.%Objective To observe the effects of different doses of dezocine on emergence agitation ( EA ) following general anesthesia for laparoscopic herniorrhaphy in children. Methods A total of 120 children who underwent laparoscopic herniorrhaphy with general anesthesia using propofol combined with remifentanil were enrolled, and were divided into four groups according to the random number table method,with 30 cases in each group. At 15 minutes before the end of surgery,group C(control group) received intravenous injection of 2 ml of normal saline,groups D1,D2 and D3 were injected intravenously with 0. 10,0. 15 and 0. 20 mg/kg of dezocine respectively. The duration to tracheal extubation,postanesthesia care unit( PACU) stay after anesthesia,and incidence rate of EA were recorded in the four groups. The Pediatric Anesthesia Emergence Delirium Scale( PAED) scores were recorded at the moment of extubation and after 10 and 30 minutes of extubation in the four groups,and the Ramsay score was recorded at 10 minutes after extubation as well. The incidence of adverse reactions was observed at 6 hours after operation in the four groups. Results The duration to tracheal extubation,PACU stay, and incidence rates of nausea and vomiting in group D3 were longer or higher than those in the other three groups(all P<0. 05),and there were no significant differences among group C,group D1 and group D2(all P>0. 05);the incidence rates of EA in group D2 and group D3 were lower than those in group C and group D1(all P<0. 05),but the incidence rate of EA in group D2 or group D3 did not statistically differ from the rate in group C or group D1(all P>0. 05). No statistically significant difference was found in the PAED score at 30 minutes after extubation among the four groups(P>0. 05). At the moment of extubation and at 10 minutes after extubation,the PAED scores in group D2 and group D3 were lower than those in group C and group D1(all P<0. 05),but no statistically difference was found between group D2 and group D3,or between group C and group D1(all P>0. 05). At 10 minutes after operation,the Ramsay score in group D3 was higher than the scores in group C,group D1 and group D2,and the Ramsay score in group D2 was higher than that in group C(all P<0. 05),but the postoperative Ramsay score in group D2 or group D1 did not statistically differ from the score in group C or group D1(all P>0. 05). Conclusion Among the children undergoing laparoscopic herniorrhaphy with general anesthesia,intravenous injection of 0. 15 mg/kg of dezocine performed at 15 minutes before the end of operation can significantly reduce the incidence rate of EA and does not prolong the duration to extubation or PACU stay,achieving few side effects.
展开▼
