摘要
目的 探讨低阿片药物麻醉对小儿腹腔镜疝修补术苏醒期躁动(EA)发生情况的影响.方法 采用单中心随机对照的研究设计方案,纳入美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级、年龄6～36个月行择期腹腔镜下疝修补术的患儿82例,采用随机数字表法分为两组(每组41例):常规组(C组)和低阿片组(DS组).两组患儿均使用七氟醚吸入诱导,麻醉镇痛方案C组采用舒芬太尼(0.3 μg/kg),DS组采用艾司氯胺酮(1 mg/kg)联合右美托咪定(0.5 μg/kg).喉罩拔除后30 min内采用小儿麻醉后苏醒期谵妄量表(PAED)每5 min评估1次EA发生情况,并记录最高PAED评分;记录入室(To)、插入喉罩前(T1)、插入喉罩后5min(T2)、切皮后5 min(T3)、术毕(T4)时的平均动脉压(MAP)及心率;拔管后30 min内采用FLACC评分每5 min评估1次疼痛情况,记录最高FLACC评分;记录补救镇痛情况、手术时间、苏醒时间、麻醉后监测治疗室(PACU)停留时间及PACU复苏期间恶心呕吐、低氧血症、喉痉挛等不良反应发生情况.结果 与C组比较,DS组EA发生率、最高PAED评分、最高FLACC评分较低(均P＜0.05).两组补救镇痛率、手术时间、拔管时间、PACU停留时间及不良反应发生率差异无统计学意义(均P＞0.05).两组心率的时间效应差异有统计学意义(P＜0.05),时间与组别交互效应差异无统计学意义(P＞0.05);MAP的时间效应差异有统计学意义(P＜0.05),时间与组别的交互效应差异有统计学意义(P＜0.05).两组各时点心率和MAP比较,差异无统计学意义(均P＞0.05).结论 低阿片药物麻醉方案在婴幼儿腹腔镜疝修补术中能够降低患儿EA的发生率和术后疼痛评分,不增加围手术期并发症.
Abstract
Objective To investigate the effect of opioid-sparing anesthesia on emergence agitation(EA)in children undergo-ing laparoscopic hernia repair.Methods A single-center randomized controlled trial was conducted.A total of 82 children,Ameri-can Society of Anesthesiologists(ASA)Ⅰ or Ⅱ,aged 6 to 36 months,who underwent elective laparoscopic hernia repair were selected.According to the random number table method,they were divided into two groups(n=41):a conventional group(group C)and an opioid-sparing group(group DS).Both groups underwent anesthesia induction with sevoflurane.Group C received sufentanil(0.3 μg/kg),and group DS received esketamine(1 mg/kg)combined with dexmedetomidine(0.5 μg/kg).Within 30 min after laryngeal mask remov-al,the incidence of EA was assessed with the Pediatric Anesthesia Emergence Delirium(PAED)scale every 5 min,and the highest PAED score was recorded.The mean arterial pressure(MAP)and heart rate were recorded at admission to the operating room(To),be-fore insertion of laryngeal mask(T,),5 min after insertion of laryngeal mask(T2),5 min after incision(T3),and at the end of operation(T4).Pain was assessed by the Face,Legs,Activity,Cry,Consolability(FLACC)scale every 5 min for 30 min after extubation,and the highest FLACC score was recorded.The use of rescue analgesia,the duration of operation,emergence time,the length of post-anesthesia care unit(PACU)stay,and the incidences of adverse reactions,such as nausea and vomiting,hypoxemia,and laryngeal spasms during the recovery period in the PACU were recorded.The use of remedial analgesia,operation time,recovery time,PACU res-idence time and the occurrence of adverse reactions such as nausea and vomiting,hypoxemia and laryngeal spasm during PACU resus-citation were recorded.Results Compared with group C,group DS showed decreases in the incidence of EA,the highest PAED score and the highest FLACC score(all P＜0.05).There were no statistical differences in the rate of rescue analgesia,the duration of op-eration,time to extubation,the length of PACU stay and the incidence of adverse reactions between the two groups(all P＞0.05).The dif-ference of time effect of heart rate between two groups was statistically significant(P＜0.05),but the difference of time and group interac-tion effect was not statistically significant(P＞0.05).The difference of time effect of MAP between two groups was statistically signifi-cant(P＜0.05),and the difference of time and group interaction effect was statistically significant(P＜0.05).There was no statistical dif-ference in heart rate and MAP between the two groups at each time point(all P＞0.05).Conclusions The opioid-sparing anesthesia strategy reduces the incidence of EA and postoperative pain score in children undergoing laparoscopic hernia repair,without increases in perioperative complications.
基金项目
国家自然科学基金(82371288)
安徽省卫生健康委员会科研项目(AHWJ2023A30202)
NETL
NSTL
万方数据