术前应用右美托咪定复合氟比洛芬酯对小儿扁桃体摘除术后躁动的影响

目的: 观察超前应用右美托咪定复合氟比洛芬酯在小儿扁桃体摘除术苏醒期的安全性和有效性。方法: 60例ASAⅠ级4～12岁行扁桃体摘除术的患儿,随机分为3组(n=20):对照组(Ⅰ组)、氟比洛芬酯组 (Ⅱ组)、氟比洛芬酯联合右美托咪定组(Ⅲ组),麻醉诱导前分别静注生理盐水 2 mL、1 mg/kg 氟比洛芬酯、1 mg/kg 氟比洛芬酯及 0.5 μg/kg 右美托咪定。所有患儿均采用咪达唑仑-芬太尼-罗库溴铵-异丙酚静脉麻醉诱导、七氟烷吸入维持麻醉。记录3组患儿拔管后各时点血压、心率、麻醉后躁动评分(PAED)和疼痛评分(CHIPPS)、术后恶心呕吐的发生率。结果: Ⅲ组患儿术中和复苏期间芬太尼追加量较Ⅰ组显著减少(P<0.05);3组复苏室低氧血症的发生率分别为25%、20%和5%,Ⅲ组发生率明显降低(P<0.01);与Ⅰ和Ⅱ组比较,Ⅲ组恶心呕吐发生率(30%)减少(P<0.01)。与Ⅰ组比较,Ⅲ组心率在拔管后5、10 min 均下降(P<0.05)。Ⅲ组PAED评分在拔管即刻、拔管后5、10 min 较Ⅰ组低(P<0.01),III组CHIPPS评分在拔管即刻、拔管后 5 min 较Ⅰ组低(P<0.05)。3组患儿麻醉后睁眼时间和拔管时间无统计学差异(P>0.05)。结论: 小儿扁桃体摘除术术前应用氟比洛芬酯联合右美托咪定可以减轻术后疼痛,减少术后躁动、恶心呕吐的发生率,且不影响患儿的苏醒时间。

The clinical application of advanced treatment of flurbiprofen and dexmedtomidine in tonsillectomy of children

AIM: To investigate the effects of advanced using flurbiprofen and dexmedetomidine in children undergoing tonsillectomy.METHODS: 60 children undergoing tonsillectomy were randomly divided into 3 groups, the control group (groupⅠ,n=20), flurbiprofen group(groupⅡ,n=20), flurbiprofen and dexmedetomidine group (groupⅢ,n=20). Children were received 2 mL saline, 1 mg/kg fiurbiprofen, 1 mg/kg fiurbiprofen and 0.5 μg/kg dexmedetomidine before induction in each group respectively. After intravenvous induction, all children were maintained with sevoflurane. Blood pressure and heart rate were recorded during operation. Agitation Scale (pediatric anesthesia emergence delirium,PAED) and analgesia (children and infants postoperative pain scale,CHIPPS) was assessed at extubation and after 5,10,15,30 minutes.RESULTS: Compared with groupⅠ,there were significant reduction in perioperative and postanesthetic recovery dosage of fentanyl in group Ⅲ.The occurrence of hypoxemia in PACU were 25%,20% and 5% in groupⅠ, Ⅱ and Ⅲ respectively. The occurrence of hypoxemia in group Ⅲ was significantly lower(P<0.01) and the same as incidence of postoperative nausea and vomiting (30%)(P<0.01). In comparison with groupⅠ, there were slower heart rate in postextubation 5 and 10 minutes,decreased PAED score and CHIPPS scale in time of extubation, postextubation 5 minutes,10 minutes in group Ⅲ. No difference was observed about time of eye open and extubation among three groups.CONCLUSION: Advanced use flurbiprofen and dexmedetomidine can relieve pain,provide stable hemodynamics and reduce incidence of postoperative nausea,vomiting and agitation.