本文選題：酮咯酸氨丁三醇　切入點：麻醉恢復(fù)期　出處：《上海醫(yī)學(xué)》2015年08期 　論文類型：期刊論文

【摘要】：目的評價酮咯酸氨丁三醇預(yù)防阻塞性睡眠呼吸暫停綜合征(OSAS)患兒全身麻醉蘇醒期躁動的效果。方法擇期行扁桃體和腺樣體切除術(shù)的OSAS患兒80例,分入治療組和對照組,每組40例。所有患兒均采用體積分?jǐn)?shù)為0.08的七氟烷加體積分?jǐn)?shù)為1的氧氣,流量8~10L誘導(dǎo),待患兒意識消失后開放外周靜脈。麻醉誘導(dǎo)給予地塞米松0.1mg/kg、阿托品0.01mg/kg、丙泊酚1.5~2.0mg/kg、羅庫溴銨0.6mg/kg、芬太尼2μg/kg,達(dá)到氣管插管要求后插入合適的氣管導(dǎo)管。術(shù)中靜脈注射丙泊酚2~4mg·kg-1·h-1、瑞芬太尼0.05~0.25μg·kg-1·min-1,并吸入體積分?jǐn)?shù)為0.01~0.025的七氟烷維持麻醉。術(shù)畢帶氣管導(dǎo)管入麻醉后恢復(fù)室,治療組予靜脈注射酮咯酸氨丁三醇0.5mg/kg,總量15mg,對照組給予等量0.9%氯化鈉溶液。記錄患兒的手術(shù)時間、自主呼吸恢復(fù)時間(手術(shù)結(jié)束至自主呼吸恢復(fù)時間)、呼名睜眼時間、拔除氣管導(dǎo)管時間、拔除氣管導(dǎo)管后呼吸道不良事件發(fā)生情況,以及術(shù)后疼痛、躁動和惡心嘔吐的發(fā)生情況。采用患兒麻醉蘇醒期躁動量化評分表(PAED)評估躁動的程度,根據(jù)面部疼痛表情量表(FPS)評估術(shù)后疼痛程度。結(jié)果治療組術(shù)后FPS評分、躁動發(fā)生率和PEAD評分均顯著低于對照組(P值均0.05),需要丙泊酚和曲馬多處理的患兒比例均顯著低于對照組(P值均0.05),術(shù)后呼吸道不良事件發(fā)生率顯著低于對照組(P0.05);兩組間術(shù)后惡心嘔吐發(fā)生率的差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論0.5 mg/kg酮咯酸氨丁三醇可安全、有效地預(yù)防OSAS患兒全身麻醉蘇醒期躁動的發(fā)生。
[Abstract]:Objective to evaluate the efficacy of ketoclorotriol in preventing restlessness during general anesthesia in children with obstructive sleep apnea syndrome (OSAS). Methods 80 patients with OSAS undergoing selective tonsillectomy and adenoidectomy were divided into treatment group and control group. 40 cases in each group were induced by volume fraction of 0.08 sevoflurane and oxygen with volume fraction of 1. The peripheral vein was opened after consciousness disappeared. Dexamethasone 0.1 mg / kg, atropine 0.01 mg / kg, propofol 1.5mg / kg, rocuronium 0.6 mg / kg, fentanyl 2 渭 g / kg were injected intravenously into the tracheal tube after they met the requirements of tracheal intubation. Phenol 2O 4 mg 路kg-1 路h-1, remifentanil 0.050.25 渭 g 路kg-1 路min-1, sevoflurane with volume fraction 0.01g 路kg-1 路min-1 were inhaled to maintain anesthesia. Tracheal catheters were inserted into the recovery chamber at the end of the operation. The treatment group received intravenous injection of ketoclorobutanol 0.5 mg / kg, total 15 mg / kg, the control group was given the same amount of sodium chloride solution 0.9%. The operation time, the time of spontaneous respiratory recovery (from the end of operation to the time of spontaneous respiratory recovery and the time of opening eyes by name) were recorded in the treatment group. The time of extubation of trachea catheter, the incidence of adverse events of respiratory tract after extubation of trachea catheter, and the occurrence of postoperative pain, restlessness, nausea and vomiting. Results the postoperative pain degree was evaluated by facial pain expression scale (FPS). Results the FPS score of the treatment group was evaluated after operation. The incidence of restlessness and PEAD score were significantly lower than those of the control group (P < 0.05), the proportion of children requiring propofol and tramadol treatment were significantly lower than those of the control group (P = 0.05), the incidence of postoperative adverse respiratory events was significantly lower than that of the control group (P 0.05). There was no significant difference in the incidence of nausea and vomiting between the two groups (P 0.05). Conclusion it is safe to use ketoprolol for 0.5 mg/kg. It can effectively prevent restlessness during general anesthesia recovery in children with OSAS.
【作者單位】： 沈陽軍區(qū)總醫(yī)院麻醉科;
【分類號】：R726.1

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