儿童术中七氟烷和地氟烷麻醉后苏醒期躁动情况比较

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摘要目的：比较儿童术中使用七氟烷和地氟烷麻醉后的苏醒期躁动情况。方法：将择期进行手术的100例患儿随机分为2组：七氟烷组（S组）50例和地氟烷组（D组）50例，患儿进入手术室后吸入8%七氟烷复合70%笑气，新鲜气体流量为10 L/min，安静后开放静脉，给予芬太尼2 μg/kg，罗库溴铵0.4 mg/kg，后行气管插管。麻醉维持中，以最低肺泡有效浓度（MAC）为计算单位，S组持续吸入七氟烷（1.0±0.2）MAC，D组吸入地氟烷（1.0±0.2）MAC，2组同时都吸入复合50%笑气，新鲜气体流量2 L/min。记录入室时、术中、拔管后的平均动脉压（MAP）、心率（HR）和血氧饱和度（SPO2）值。术毕拔管入麻醉后恢复室（PACU），之后每10 min记录躁动PAED评分、改良Aldrete和术后CHIPPS疼痛评分。结果：术后D组患儿入PACU时和入PACU后10 min的躁动PAED评分明显低于S组（P＜0.01）；D组患儿入PACU时和入PACU后10 min的改良Aldrete评分明显高于S组（均P＜0.05）；入PACU时的CHIPPS疼痛评分，D组明显低于S组（P＜0.01）。结论：与七氟烷比较，儿童术中使用地氟烷能减少术后苏醒期躁动情况。

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关键词 ：儿童, 外科手术, 吸入麻醉, 麻醉剂, 苏醒期躁动

Abstract：Objective: To compare the emergence agitation in pediatric patients undergoing minor ENT surgery under sevoflurane or desflurane anesthesia. Methods: One hundred children of 1-7 years old undergoing minor ear-nose-throat (ENT) surgery were randomly divided into two groups: 50 cases in sevoflurane group (S group) and 50 cases in desflurane group (D group). After inhaled 8% sevoflurane combined 70% nitrous oxide with 10 L/min fresh gas, an IV was established and fentanyl 2 μg/kg followed by rocuronium 0.4 mg/kg was administered to facilitate endotracheal intubation. For maintenance of anesthesia, children were randomly assigned to receive either sevoflurane (1.0±0.2 ) MAC or desflurane (1.0±0.2) MAC, with a constant fresh gas flow of 2 L/minnute of 50% nitrous oxide in oxygen. The HR, MAP, SPO2 of admission to OR (T1), during the operation (T2), after extubation (T3) were recorded. Besides, degree of agitation using PAED scale, modified Aldrete scores and CHIPPS scores on admission to PACU were all recorded and followed every 10 minutes. Results: PAED scores in D group were significantly lower than S group at admission and 10 minnutes after PACU (P<0.01). Modified Aldrete scores in D group were also significantly higer than S group at admission and 10 minnutes in PACU (P<0.01, P<0.05). Besides, CHIPPS pain score in D group was significantly lower than S group when arriving in PACU (P<0.01). Conclusion: The emergence agitation associated with the use of desflurane is lower than sevoflurane anesthesia in children undergoing minor ENT surgery.

Key words： children surgery inhalation anesthesia anesthetic emergence agitation

收稿日期: 2017-02-02

基金资助:温州市科技计划项目（Y20140318）。

通讯作者: 连庆泉，主任医师，教授，Email：lianqingquanmz@163.com。

作者简介: 叶雪飞（1982-），女，浙江温州人，主治医师，硕士

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I2/131

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