摘要
目的 分析不同剂量舒芬太尼在小儿扁桃体腺样体切除术(简称扁腺手术)中的应用效果。方法 选取行小儿扁腺手术的患儿111例,病例纳入时间为2023年1月至2024年10月,收集地点为赣州市妇幼保健院,予以随机数字表法将所选患儿分为A组、B组和C组,各37例。A组、B组和C组麻醉诱导分别给予舒芬太尼0.25、0.30和0.35μg/kg。比较三组围术期各时间,术后早期(患儿拔管后30 min内)疼痛及躁动情况,麻醉诱导前(T_(0))、气管插管即刻(T_(1))、手术开始即刻(T_(2))、拔管时(T_(3))的血流动力学,观察期间的不良反应及出院时的家长满意度。结果 A、B组拔管、自主呼吸恢复、苏醒及麻醉恢复室停留时间均短于C组(P<0.05)。术后早期,B、C组疼痛行为评分(FLACC)、小儿麻醉苏醒期躁动(PAED)评分均低于A组(P<0.05);B、C组疼痛、躁动发生率(5.41%、8.11%;2.70%、5.41%)均低于A组(40.54%、45.95%)(P<0.05)。与T_(0)时比较,A组T_(1)、T_(2)、T_(3)时的平均动脉压(MAP)、心率(HR)均升高(P<0.05);B、C组T_(1)、T_(2)、T_(3)时的MAP、HR均低于A组(P<0.05)。观察期间,B、C组呛咳发生率(16.22%、13.51%)低于A组(51.35%)(P<0.05);A、B组恶心呕吐、嗜睡发生率(2.70%、16.22%;5.41%、18.92%)低于C组(24.32%、62.16%)(P<0.05)。出院时,B组家长满意度评分为(9.12±0.25)分,高于A组和C组[(7.91±0.33)、(7.93±0.41)]分(P<0.05)。结论 小儿扁腺手术中应用0.30μg/kg的舒芬太尼效果更佳,可缩短患儿围术期各时间,维持血流动力学稳定,减少术后疼痛、躁动、呛咳、恶心呕吐及嗜睡的发生,提高安全性,并可提升患儿家长的满意度。
Objective To analyze the effect of different doses of sufentanil in pediatric tonsil adenoidectomy(referred to as tonsil surgery).Methods 111 cases of children who underwent pediatric squamous gland surgery were selected,and the cases were included from January 2023 to October 2024,and the collection site was Ganzhou Maternal and Child Health Hospital,the selected children were divided into the group A,B,and C by randomized numerical table method,each with 37 cases.0.25μg/kg of sufentanil was given to group A,0.30μg/kg of sufentanil was given to group B,0.35μg/kg of sufentanil was given to group C.The perioperative times,the pain and agitation conditions in the early postoperative period(Within 30 min after extubation),the hemodynamics before the induction of anesthesia(T_(0)),the immediate moment of endotracheal intubation(T_(1)),the immediate start of the surgery(T_(2)),and hemodynamics at extubation(T_(3)),the adverse effects during observation and the parental satisfaction at discharge of the three groups were compared.Results The times of extubation,autonomic respiration recovery,awakening and anesthesia recovery room stay were shorter in the group A,B than in the group C(P<0.05).Early postoperative period,the scores of face legs activity crying consolability(FLACC)and pediatric anesthesia agitation during awakening(PAED)were lower in the groups B,C than in the group A(P<0.05);and the incidence of pain and agitation in the groups B,C(5.41%,8.11%;2.70%,5.41%)was lower than in the group A(40.54%,45.95%)(P<0.05).Compared with that at T_(0),the mean arterial pressure(MAP)and heart rate(HR)at T_(1),T_(2),and T_(3) were elevated in the group A(P<0.05);MAP and HR at T_(1),T_(2) and T_(3) were lower in the groups B,C than in the group A(P<0.05).During the observation period,the incidence of choking and coughing in the groups B,C(16.22%,13.51%)was lower than that in the group A(51.35%)(P<0.05);the incidence of nausea and vomiting and drowsiness in the groups A,B(2.70%,16.22%;5.41%,18.92%)was lower than that in the group C(24.32%,62.16%)(P<0.05).At the time of discharge,the parental satisfaction score in the group B was(9.12±0.25),which was higher than that in the groups A and C[(7.91±0.33),(7.93±0.41)](P<0.05).Conclusions The application of 0.30μg/kg sufentanil in pediatric squamous gland surgery is more effective,which could shorten the time of each perioperative period,maintain hemodynamic stability,reduce the occurrence of postoperative pain,agitation,choking,nausea and vomiting,and somnolence,and improve the safety,as well as enhance the parental satisfaction of the children.
作者
丁称生
刘荣
叶昌盛
DING Chengsheng;LIU Rong;YE Changsheng(Department of Anesthesiology,Ganzhou Women and Children′s Health Care Hospital,Ganzhou 341000,Jiangxi,China)
出处
《实用医学杂志》
北大核心
2025年第17期2734-2739,共6页
The Journal of Practical Medicine
基金
江西省卫生健康委科技计划项目(编号:202140693)。
