摘要
目的探讨拔管时机对幼儿七氟醚复合麻醉恢复期躁动的影响。方法将择期行腭裂手术的患儿90例,随机分为3组(n=30)。常规气管插管后,七氟醚、丙泊酚、瑞芬太尼静吸复合维持全麻。手术结束前10 min停止丙泊酚输入,5 min停止瑞芬太尼输入,减小七氟醚吸入浓度至1%。术毕停七氟醚吸入,将氧流量调至6 L/min。分别于5 min内(A组)、5~10 min(B组)、10 min以上(C组)拔除气管导管。记录停七氟醚吸入至苏醒时间,苏醒后出室时间。3组患儿拔除气管导管时及出手术室时给予躁动评分。结果 3组患儿苏醒时间A组(21.8±2.5)min、B组(21.4±2.1)min、C组(20.9±1.3)min差异无统计学意义(P>0.05)。3组患儿出室时间分别是A组(8.1±1.6)min、B组(5.2±2.0)min、C组(2.1±0.7)min,差异有统计学意义(P<0.05)。拔除气管插管时,A组躁动发生率(26/30)高于B组(16/30)和C组(5/30),差异有统计学意义(P<0.05)。B组躁动发生率与C组差异也有统计学意义(P<0.05)。结论复合七氟醚吸入全身麻醉的患儿,术毕通过适当给予丙泊酚控制呛咳,延长拔管时间至停止七氟醚吸入10 min以后,可有效减少术后躁动的发生,最佳拔管时间是停止七氟醚吸入后15 min。
Objective To investigate the influence of trached extubation time on the emergent agitation during the recovery of sevoflurane combined anesthesia in infants. Methods Sevoflurane, propofol and remifentanil were combined to maintain general anesthesia after intubation. The propofol infusion was stopped 10 minutes before the operation, and the remifentanil infusion was stopped 5 minutes before the end of the operation. The sevoflurane concentration was reduced to 1%, and the oxygen flow was adjusted to 6 L/min when the sevoflurane inhalation was stopped. Ninety infant patients with cleft palate were randomized into 3 groups （n=30）： 30 patients in group A were extubated within 5 minutes, 30 patients in group B were extubated between 5 and 10 minutes, and 30 patients in group C were extubated after 10 minutes. A postoperative agitation score was given after extubation and recorded away from the operating room. Propofol was administered when agitation occurred. The recovery time after the operation and time away from the operating room were recorded. Results The recovery times of group A, group B, and group C were 21.8 ± 2.5 minutes, 21.4 ± 2.1 minutes and 20.9 ± 1.3 minutes, respectively, although the differences were not significant （P 〉 0.05）. The times away from the operating room of group A, group B, and group C were 8.1 ± 1.6 minutes, 5.2 ± 2.0 minutes and 2.1 ± 0.7 minutes, respectively, and the differences were statistically significant （P 〈 0.05）. When endotracheal intubation was removed, the incidence of agitation in group A （26/30） was higher than that in group B （16/30） and group C （5/30）, and the differences were statistically significant （P 〈 0.05）. The incidence of agitation in group B was also significantly different from that in group C （P 〈 0.05）. Conclusion Propofol, which is used to control coughing and prolong the extubation time, can effectively prevent emergent agitation during the recovery period from sevoflurane-based anesthesia in infants. The optimum time of extubation was 15 minutes.
作者
夏璇
徐波
康伟
雷蕾
姚林川
李正强
辛忠
XIA Xuan;XU Bo;KANG Wei;LEI Lei;YAO Linchuan;LI Zhengqiang;XIN Zhong(Department of Anesthesiology,Stomatological Hospital,Southern Medical University,Guangzhou 510280,China;Department of Anesthesiology,Guangzhou General Hospital of Guangzhou Military Command,Guangzhou 510010,China;Department of Anesthesiology,Beijing Children＇s Hospital,Capital Medical University,Beijing 100045,China)
出处
《口腔疾病防治》
2018年第8期526-529,共4页
Journal of Prevention and Treatment for Stomatological Diseases
基金
国家自然科学基金项目(61773130)
关键词
全身麻醉
拔管时机
七氟醚
麻醉苏醒
术后躁动
幼儿
General anesthesia
Optimum time point
Sevoflurane
Anesthesia recovery period
Agitation
Infant
