舒芬太尼对小儿七氟烷全麻苏醒期躁动的影响

摘要

目的：观察舒芬太尼预防小儿七氟烷全麻苏醒期躁动的有效性和安全性。方法选择ASAⅠ～Ⅱ级择期全麻下行阴茎部位手术患儿40例，年龄3～9岁，随机分为舒芬太尼组（ S组）和对照组（ C组）两组，每组20例，在手术结束前10 min S组给予舒芬太尼0.1μg ／kg，C组给予生理盐水3 ml。记录术毕前10 min给药前（基础值）（T0）、拔管时（T1）、拔管后5 min （T2）和离开复苏室前（T3）四个时间点的平均动脉压（MAP）、心率（HR）、血氧饱和度（ SPO2），并于各时点抽外周静脉血测定肾素和皮质醇浓度，记录自主呼吸恢复时间、意识恢复时间及拔管时间，并测定全麻苏醒期镇静评分（Comfort）和躁动评分（RS），观察恶心、呕吐、呼吸抑制和返流误吸等不良反应的发生情况。结果 T1～T3时点S组的MAP、HR与C组对应时点相比显著降低（ P＜0.05）。 C组肾素、皮质醇在T1～T3时点与T0时点相比升高差异有显著性（P＜0.05），并且与S组对应时点相比升高差异也有显著性（P＜0.05）。拔管期间C组中度和重度躁动发生率明显高于S组（P＜0.05），S组躁动发生率低，镇静满意率高。与C组比， S组术后恶心呕吐、呼吸抑制、返流误吸不良反应的发生差异无显著性（ P＞0.05），在自主呼吸恢复时间，意识恢复时间及拔管时间上差异也无显著性（ P＞0.05）。结论术毕前10 min静注舒芬太尼0.1μg／kg能明显降低小儿七氟烷全麻苏醒期躁动发生率，且因舒芬太尼0.1μg／kg不影响拔管时间，不增加术后不良反应发生率，适合在小儿麻醉中广泛安全使用。%Objective To observe the efficiency and safety of sufentanil in preventing agitation in the recovery period of sevoflurane general anesthesia in children .Methods We randomly assinged 40 children for the operation of the penis , ASAⅠ~Ⅱ, Age 3~9 years old.40 children were randomly devided into two groups , sufentanil group (S group) and con-trol group (C group),20 cases in each group.10 min before the end of the operation S group was given sufentanil 0.1 μg /kg.C group was received saline 3ml.The mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SPO2) were recorded at four timepoints:10 minutes before the completion of the drug (the basic value) (T0), when pul-ling out the tracheal tube (T1), 5 minutes after pulling out the tracheal tube (T2).The time before leaving the recovery room (T3), and the concentration of renin and cortisol were measured by peripheral venous blood at different time points .The re-covery time of spontaneous breathing , recovery time and extubation time were recorded .Sedation score (Comfort) and agita-tion score (RS) were measured.The occurrence of adverse reactions such as nausea , vomiting, respiratory depression and reflux aspiration were observed .Results T1~T3 time S group of MAP, HR and C group corresponds to a significant reduc-tion in time (P<0.05).In group C, there was a significant difference between the T1~T3 time and T0 point at the time of the levels of renin and cortisol (P<0.05), and compared with the S group also had significant differences in point (P<0.05).During extubation period, the incidence of moderate and severe agitation in group C was significantly higher than in group S (P<0.05).The occurrence rate of agitation in group S was low , and the rate of sedation satisfaction was high . Compared with group C , there was no significant difference in the incidence of postoperative nausea and vomiting and respira -tory depression between the two groups (P>0.05).There was no significant difference in the incidence of adverse reactions (P>0.05).Conclusion 10 mins before the end of the operation , intravenous sufentanil 0.1 μg/kg can significantly re-duce the sevoflurane anesthesia restlessness .And because sufentanil 0.1μg/kg did not affect the extubation time , does not increase the incidence of postoperative adverse reactions , suitable for wide use in pediatric anesthesia .