摘要
目的探讨右美托咪定联合舒芬太尼在全身麻醉小儿扁桃体腺样体切除术后的镇痛效果。方法选取2021年9月至2022年9月于宜春市人民医院耳鼻喉科行扁桃体腺样体切除术的90例患儿作为研究对象,按照随机数字表法分为A组、B组与C组,每组30例。患儿均给予全身麻醉,A组予以舒芬太尼2.0μg/kg镇痛镇静方案,B组予以舒芬太尼1.5μg/kg+右美托咪定1μg/kg镇痛镇静方案,C组予以舒芬太尼2.0μg/kg+右美托咪定1μg/kg镇痛镇静方案。比较3组术后恢复指标、应激反应指标[白细胞介素-6(interleukin-6,IL-6)、皮质醇、儿茶酚胺]、视觉模拟评分法(visual analogue scale,VAS)评分、Ramsay镇静评分、匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评分、心率、血压及不良反应发生情况。结果C组拔管时间、意识完全苏醒时间、自主呼吸恢复时间均短于A组和B组,差异有统计学意义(P<0.05)。C组术后血清IL-6、皮质醇、儿茶酚胺水平均低于A组和B组,差异有统计学意义(P<0.05)。术后拔管后6 h(T0)、术后拔管后12 h(T1)、术后拔管后24 h(T2)、术后拔管后48 h(T3),C组VAS评分均低于A组和B组,差异有统计学意义(P<0.05)。T0~T3时,C组Ramsay镇静评分均高于A组和B组,差异有统计学意义(P<0.05)。C组术后心率快于A组和B组,舒张压、收缩压均低于A组和B组,差异有统计学意义(P<0.05)。C组睡眠时间、睡眠质量、睡眠效率、入睡时间、睡眠障碍、睡眠药物及日间功能评分均低于A组和B组,差异有统计学意义(P<0.05)。C组术后不良反应发生率低于A组和B组,差异有统计学意义(P<0.017)。结论与低剂量舒芬太尼比较,高剂量舒芬太尼联合右美托咪定应用于全身麻醉小儿扁桃体腺样体切除术后的镇痛镇静效果更佳,可减轻患儿应激反应,改善睡眠质量,且安全性较高。
Objective To explore the analgesic effect of dexmedetomidine combined with sufentanil after tonsillectomy and adenoidectomy in children under general anesthesia.Methods 90 children who underwent tonsillectomy and adenoidectomy in the department of Otorhinolaryngology of Yichun People's Hospital from September 2021 to September 2022 were selected as study subjects,they were divided into the group A,group B and the group C according to the random number table method,with 30 cases in each group.General anesthesia was administered to all children,the group A was given the analgesic and sedative regimen of sufentanil 2.0μg/kg,the group B was given the analgesic and sedative regimen of sufentanil 1.5μg/kg+dexmedetomidine 1μg/kg,the group C was given the analgesic and sedative regimen of sufentanil 2.0μg/kg+dexmedetomidine 1μg/kg.The postoperative recovery indicators,stress response indicators(interleukin-6[IL-6],cortisol,catecholamines),visual analogue scale(VAS)score,Ramsay sedation score,Pittsburgh sleep quality index(PSQI)score,heart rate,blood pressure and incidence of adverse reactions were compared among the three groups.Results The extubation time,time of complete awakening of consciousness and the time of recovery of spontaneous respiration in the group C were shorter than those in the group A and the group B,the differences were statistically significant(P<0.05).The postoperative serum IL-6,cortisol and catecholamine levels in the group C were lower than those in the group A and the group B,the differences were statistically significant(P<0.05).After postoperative extubation at 6 h(T0),after postoperative extubation at 12 h(T1),after postoperative extubation at 24 h(T2),after postoperative extubation at 48 h(T3),the VAS scores in the group C were lower than those in the group A and group B,the differences were statistically significant(P<0.05).At T0-T3,Ramsay sedation scores in the group C were higher than those in the group A and group B,the differences were statistically significant(P<0.05).The postoperative heart rate in the group C was faster than that in the groups A and B,and diastolic and systolic blood pressure were lower than those in the group A and group B,the differences were statistically significant(P<0.05).The length of sleep,sleep quality,sleep efficiency,sleep onset,sleep disorders,sleep medication and daytime function scores in the group C were lower than those in the group A and group B,the differences were statistically significant(P<0.05).The incidence of postoperative adverse reactions in the group C was lower than that in the group A and group B,the difference was statistically significant(P<0.017).Conclusion Compared with low-dose sufentanil,high-dose sufentanil combined with dexmedetomidine has better analgesic and sedative effect after tonsillectomy and adenoidectomy in children under general anesthesia,it can reduce the stress response of children,improve sleep quality,and has higher safety.
作者
甘露平
胡德铭
欧阳年春
吴生洋
GAN Luping;HU Deming;OUYANG Nianchun;WU Shengyang(Department of Anesthesiology,Yichun People's Hospital,Yichun,Jiangxi,336000,China)
出处
《当代医学》
2024年第29期1-5,共5页
Contemporary Medicine
基金
宜春市指导性科技计划项目(2022ZDJH6119)。
