右美托咪定滴鼻联合酮咯酸氨丁三醇超前镇痛对患儿术后疼痛的影响*

摘要:

目的 探讨术前右美托咪定滴鼻联合超前镇痛模式应用酮咯酸氨丁三醇对小儿术前焦虑、术后疼痛和苏醒期躁动的影响。方法 选择拟全身麻醉下行扁桃体和腺样体切除术患儿90例,男53例,女37例,年龄3～7岁,BMI18～24kg/m_²,ASAⅠ或Ⅱ级。采用随机数字表法分为3组：右美托咪定组(D组)、酮咯酸氨丁三醇组(K组)和右美托咪定联合酮咯酸氨丁三醇组(DK组),每组30例。入室前30min,D组和DK组给予右美托咪定1μg/kg滴鼻,K组给予等容量生理盐水。麻醉诱导前10 min,D组静脉注射等容量生理盐水,K组和DK组静脉注射酮咯酸氨丁三醇0.5mg/kg(最大剂量不超过15mg)。术中吸入七氟醚维持麻醉。记录术前镇静满意情况、面罩接受程度,记录拔管后5、10、30min和1h时FLACC疼痛评估量表法评分(FLACC评分)、苏醒期谵妄躁动评分(PAED评分)和Ramsay评分,并记录患儿拔管后2h内恶心呕吐、低氧血症、呼吸抑制、苏醒延迟、瘙痒和鼻咽部出血等不良反应。结果 D组和DK组术前镇静满意率和诱导面罩接受率明显高于K组(P<0.05)。拔管后5、10、30min和1h,K组和DK组FLACC评分明显低于D组(P<0.05),DK组FLACC评分明显低于K组(P<0.05),DK组PEAD评分明显低于K组和D组,Ramsay评分明显高于K组和D组(P<0.05)。三组拔管后2h内均未发生恶心呕吐、低氧血症、呼吸抑制、反流误吸、苏醒延迟、瘙痒和鼻咽部出血等不良反应。结论 患儿麻醉诱导前右美托咪定1μg/kg滴鼻联合术前预防性给予酮咯酸氨丁三醇0.5mg/kg可获得安全有效的镇静作用,明显缓解患儿术后疼痛,有效预防患儿苏醒期躁动。

Abstract:

Objective To evaluate the influence of intranasal dexmedetomidine combined with the preemptive analgesia with ketorolac tromethamine on postoperative pain in pediatric patients. Methods Ninety patients, including 53 boys and 37 girls, aged 3~7yr, BMI 18~24kg/m_², ASA physical statusⅠorⅡ, scheduled for elective tonsillectomy and adenoidectomy under general anesthesia, were randomized into three groups (n =30 each): dexmedetomidine group (group D) , ketorolac tromethamine group (group K), dexmedetomidine plus ketorolac tromethamine group (group DK) .Dexmedetomidine 1μg/kg were given intranasally at 30min before admission to operating room in group D and group DK, while the equal volume of normal saline was given intranasally in group K. The pediatric patients in group K and group DK at 10min before intubation received ketorolac tromethamine intravenously 0.5mg/kg (the maximum dose is less than 15mg), while patients in group D received the equal volume of normal saline intravenously. And sevoflurane was given to maintaining anesthesia. The sedation scores and the mask acceptance rate before operation, the time of operation and recovery were recorded. The FLACC score, PAED score and Ramsay score were recorded respectively at 5min,10min, 30min and 60min after extubation. Adverse reactions within 2hours after extubation were evaluated, such as the nausea and vomiting, hypoxemia (SpO₂<90%), respiratory depression, delayed recovery, pruritus and nasopharyngeal hemorrhage. Results Compared with group K, the satisfactory rate of sedation and the mask acceptance rate before operation in group D and DK were elevated significantly (P<0.05). At 5 min,10 min, 30 min and 60 min respectively after extubation, the FLACC score was lower in group D and DK than group K (P<0.05), and more lower in group DK (P<0.05). Compared with group K and D, the PAED scores decreased significantly (P<0.05), while the Ramsay scores elevated significantly (P <0.05). There were no adverse reactions in the three groups within 2 hours after extubation. Conclusion The application that dexmedetomidine 1μg/kg intranasally combined with the preemptive analgesia of ketone tromethamine 0.5mg/kg before the induction of general anesthesia, not only can obtain better sedation and significant analgesic effect, but also significantly reduce the agitation during recovery.