地佐辛预防小儿全身麻醉苏醒期躁动的临床研究

Preventive effect of Dezocine on emergence agitation in children with general anesthesia

摘要:

评价地佐辛对小儿七氟烷复合麻醉下行唇腭裂修复术后苏醒期躁动的预防作用。方法以海南省人民医院择期行唇腭裂修复手术患儿60例为研究对象，随机分为研究组（n =30）和对照组（n =30）。手术结束前15 min 研究组患儿静脉注射地佐辛0.10 mg/kg，对照组注射等容量生理盐水。记录手术时间，拔除气管导管时间，入麻醉监护治疗室（PACU）时改良Aldrete 评分，PACU 滞留时间；同时记录躁动评分（PAED）、改良东安大略儿童医院疼痛评分（m-CHEOPS）、苏醒期躁动发生情况以及术毕6 h内不良反应的发生情况。同时记录插管时（T0）、拔管时（T1）、拔管后5 min（T2）时患儿生命体征。结果两组患儿性别、年龄、体重、手术时间及七氟醚吸入浓度等比较，差异无统计学意义（p >0.05）。研究组患儿PAED 评分及m-CHEOPS 评分低于对照组；研究组苏醒期躁动发生率低于对照组（χ2=13.871，p =0.000）。两组患儿拔管时间、入PACU 即刻改良Aldrete 评分及PACU 滞留时间比较，差异无统计学意义（p >0.05）。T1 和T2 时研究组的平均动脉压低于对照组，心率慢于对照组。研究组患儿对地佐辛耐受良好，无不良反应发生。结论手术结束前静脉注射地佐辛可有效抑制小儿唇腭裂修复术全身麻醉后苏醒期躁动的发生，不延长患儿术后苏醒及拔管时间，且无不良反应。

Abstract:

To evaluate the preventive effect of Dezocine on emergence agitation in children after cleft lip and palate repair under combined anesthesia with Sevoflurane. Methods Sixty children who underwent cleft lip and palate repair were randomly divided into study group and control group with 30 cases in each group. At the 15th min before the end of the operation, the children in the study group were intravenously injected with Dezocine 0.10 mg/kg, the control group was injected with the same volume of saline. Operation time, extubation time, modified Aldrete score when entering into the Post-anesthesia Care Unit (PACU) and PACU retention time were recorded. At the same time, Pediatric Anesthesia Emergence Delirium (PAED) score, Modified Children's Hospital of Eastern Ontario Pain Scale (m-CHEOPS) score, the incidence of emergence agitation and side effects within 6 h after operation were recorded. Vital signs of all children during intubation (T0), extubation (T1), and 5 min after extubation (T2) were also recorded. Results There was no significant difference in sex, age, body weight, operation time or Sevoflurane inhalation concentration between the two groups (p > 0.05). The PAED score and the m-CHEOPS score in the study group were significantly lower than those in the control group (p < 0.05). The incidence of emergence agitation was significantly lower in the study group than in the control group (x2 = 13.871, p= 0.000). There was no significant difference in the extubation time, the modified Aldrete score or PACU retention time between the two groups. The MAP of the study group was significantly lower than that of the control group, and the HRwas significantly slower than that of the control group at T1 and T2 (p < 0.05). In the study group, the patients were well tolerated to Dezocine without significant adverse reactions. Conclusions In children with cleft lip and palate repair, intravenous administration of Dezocine before the end of surgery can effectively restrain the onset of emergence agitation after general anesthesia, without prolonging awakening and extubation time or obvious adverse reactions.