摘要
目的观察氟比洛芬酯、曲马多、氯胺酮用于全麻下小儿扁桃体和腺样体切除术后患者的镇痛效果及安全性，以及找到适合小儿短小手术的超前镇痛药物，从而减少小儿全麻苏醒期的躁动及减轻术后疼痛。方法选择择期在全麻行扁桃体、腺样体切除术的患儿80例，年龄4岁-14岁，美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级。采用完全随机双盲法将患儿分为4组：F组为氟比洛芬酯超前镇痛组，K组为氯胺酮超前镇痛组，T组为曲马多超前镇痛组，C组为空白对照组，每组20例。F组于手术开始前10min缓慢静脉注射氟比洛芬酯1mg／kg。K组于手术开始前10min缓慢静脉注射氯胺酮0．5mg／kg。T组于手术开始前10min缓慢静脉注射曲马多2mg／kg。C组于手术开始前10min缓慢静脉注射生理盐水3ml。观察术后镇痛评分，苏醒期躁动评分，循环、呼吸、血氧饱和度变化及副作用。结果术后苏醒期躁动评分F组、K组和T组明显低于C组。术后0hF组、K组、T组视觉模拟（VAS）评分和改良目的评分法（MOPS评分）分别为（O．6±1．0）和（0．8±1．0）、（1．9±1．9）和（1．8±1.7）、（0．8±1．4）和（0．8±1．3），均明显低于C组的（3．7±1．7）和（3．5±1．5）（P〈0．01）；F组VAS评分在术后8h为（0．9±1．0）显著低于K组（1．8±1．7）、T组（1．8±0．7）和C组（1．7±0．7）（P〈O．01）；F组MOPS评分为（0．3±0．7）在术后8h低于C组（0．7±0．6）（P〈O．05）；F组和T组VAS评分在术后0h低于K组（P〈0．05）。4组术后各个时点的循环、呼吸、血氧饱和度变化均在正常范围，F组血压在术后0h显著低于K组、T组和C组，组间比较差异有统计学意义（P〈0．01）。4组均无心律失常、呼吸抑制、凝血功能异常发生，恶心、呕吐、头晕、烦躁、做噩梦、腹痛等副作用发生率4组之间差异无统计学意义（P〉0．05）。术后睡眠不佳发生率C组高于F组（P〈0．05）。结论氟比洛芬酯、氯胺酮、曲马多均能有效减少苏醒期躁动，但氯胺酮、曲马多均未显示超前镇痛效果，氟比洛芬酯超前镇痛效果良好，作用时间长，能有效缓解小儿短小手术的术后疼痛，无明显副作用，可安全用于小儿短小手术的术后镇痛。
Objectives The aim of this study was to observe analgesic effect and safety with flurbiprofen axietil, tramadol, ketamine anesthesia in children after tonsillectomy and adenoidectomy, as well as to find suitable drugs for short operation preemptive analgesia in children to reduce the agitation after general anesthesia and postoperative pain in pediatric patients. Methods In this study, eighty patients （4 to 14 years old ）scheduled for tonsillectomy and adenoidectomy were randomly divided into four groups （n=20）. Group F received preoperative intravenous administration of flurbiprofen axietil 1 mg/kg at 10 min before surgery. Group K received preoperative intravenous administration of ketamine 0.5 mg/kg at 10 min before surgery. Group T received preoperative intravenous administration of tramadol 2 mg/kg at 10 min before surgery. Group C received preoperative intravenous administration 3 ml saline at 10 min before surgery. Observed VAS score, restlessness scores, MOPS score, BP and HR, RR and VT, oxygen saturation and adverse reactions. Results Restlessness scores in thw group F, the group K and the group T were significiantly lower than in the group C. VAS score and MOPS scores in the group F （0.6±1.0 and 0.8±1.0）,the group K （ 1.9±1.9 and 1.8±1.7）, the group T （0.8±1.4 and 0.8±1.3） at 0 h after operation were significantly lower than in the group C （3.7±1.7 and 3.5±1.5 ） （P〈0.01）; at 8 h after operation, VAS score in the group F （0.9＋1.0） was significantly lower than in the group C （1.7±0.7）, the group K （1.8±1.7） and the group T （1.8±0.7） （P〈0.01）; MOPS score in the group F （0.3±0.7） was lower than in the group C （0.7±0.6）（P〈0.05） at 8 h after operation; VAS score in the group F and the group T was lower than in the Group K （P〈 0.05） at 0 h after operation. BP and HR, RR and VT, oxygen saturation changes in all four groups are in the normal range. Blood pressure in the group F was significantly lower than in the group K, the group T and the group C at 0 h after operatio （P〈0.01）. No arrhythmia, respiratory inhibition, coagulant function abnormality were found in four groups. There was no statistical significance between four groups in Nausea, vomiting, dizziness, agitated, nightmares, abdominal pain and other adverse reaction. The incidence of postoperative poor sleep in the group C was higher than in the group F （P〈0.05）. Conclusions Flurbiprofen axietil, ketamine, tramadol effectively reduced restlessness during recovery. Ketamine and tramadol showed no effect of preemptive analgesia. Flurbiprofen axietil effectively relieved postoperative pain in children. Flurbiprofen axietil can be safely used for postoperative analgesia in children during minor surgery.
出处
《国际麻醉学与复苏杂志》
CAS
2012年第7期443-447,共5页
International Journal of Anesthesiology and Resuscitation
