国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2012年
7期
443-447
,共5页
超前镇痛%小儿扁桃体、腺样体切除术%氟比洛芬酯%氯胺酮%曲马多
超前鎮痛%小兒扁桃體、腺樣體切除術%氟比洛芬酯%氯胺酮%麯馬多
초전진통%소인편도체、선양체절제술%불비락분지%록알동%곡마다
Preemptive analgesia%Tonsillectomy and adenoidectomy in children%Flurbiprofen axietil%Ketamine%Tramadol
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10 min缓慢静脉注射氟比洛芬酯1 mg/kg.K组于手术开始前10 min缓慢静脉注射氯胺酮0.5 mg/kg.T组于手术开始前10 min缓慢静脉注射曲马多2 mg/kg.C组于手术开始前10 min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(0.6±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＜0.01)；F组MOPS评分为(0.3±0.7)在术后8h低于C组(0.7±0.6)(P＜0.05)；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.
目的 觀察氟比洛芬酯、麯馬多、氯胺酮用于全痳下小兒扁桃體和腺樣體切除術後患者的鎮痛效果及安全性,以及找到適閤小兒短小手術的超前鎮痛藥物,從而減少小兒全痳囌醒期的躁動及減輕術後疼痛.方法 選擇擇期在全痳行扁桃體、腺樣體切除術的患兒80例,年齡4歲～14歲,美國痳醉醫師協會(ASA)分級I～Ⅱ級.採用完全隨機雙盲法將患兒分為4組:F組為氟比洛芬酯超前鎮痛組,K組為氯胺酮超前鎮痛組,T組為麯馬多超前鎮痛組,C組為空白對照組,每組20例.F組于手術開始前10 min緩慢靜脈註射氟比洛芬酯1 mg/kg.K組于手術開始前10 min緩慢靜脈註射氯胺酮0.5 mg/kg.T組于手術開始前10 min緩慢靜脈註射麯馬多2 mg/kg.C組于手術開始前10 min緩慢靜脈註射生理鹽水3ml.觀察術後鎮痛評分,囌醒期躁動評分,循環、呼吸、血氧飽和度變化及副作用.結果 術後囌醒期躁動評分F組、K組和T組明顯低于C組.術後0hF組、K組、T組視覺模擬(VAS)評分和改良目的評分法(MOPS評分)分彆為(0.6±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),均明顯低于C組的(3.7±1.7)和(3.5±1.5)(P＜0.01)；F組VAS評分在術後8h為(0.9±1.0)顯著低于K組(1.8±1.7)、T組(1.8±0.7)和C組(1.7±0.7)(P＜0.01)；F組MOPS評分為(0.3±0.7)在術後8h低于C組(0.7±0.6)(P＜0.05)；F組和T組VAS評分在術後0h低于K組(P＜0.05).4組術後各箇時點的循環、呼吸、血氧飽和度變化均在正常範圍,F組血壓在術後0h顯著低于K組、T組和C組,組間比較差異有統計學意義(P＜0.01).4組均無心律失常、呼吸抑製、凝血功能異常髮生,噁心、嘔吐、頭暈、煩躁、做噩夢、腹痛等副作用髮生率4組之間差異無統計學意義(P＞0.05).術後睡眠不佳髮生率C組高于F組(P＜0.05).結論 氟比洛芬酯、氯胺酮、麯馬多均能有效減少囌醒期躁動,但氯胺酮、麯馬多均未顯示超前鎮痛效果,氟比洛芬酯超前鎮痛效果良好,作用時間長,能有效緩解小兒短小手術的術後疼痛,無明顯副作用,可安全用于小兒短小手術的術後鎮痛.
목적 관찰불비락분지、곡마다、록알동용우전마하소인편도체화선양체절제술후환자적진통효과급안전성,이급조도괄합소인단소수술적초전진통약물,종이감소소인전마소성기적조동급감경술후동통.방법 선택택기재전마행편도체、선양체절제술적환인80례,년령4세～14세,미국마취의사협회(ASA)분급I～Ⅱ급.채용완전수궤쌍맹법장환인분위4조:F조위불비락분지초전진통조,K조위록알동초전진통조,T조위곡마다초전진통조,C조위공백대조조,매조20례.F조우수술개시전10 min완만정맥주사불비락분지1 mg/kg.K조우수술개시전10 min완만정맥주사록알동0.5 mg/kg.T조우수술개시전10 min완만정맥주사곡마다2 mg/kg.C조우수술개시전10 min완만정맥주사생리염수3ml.관찰술후진통평분,소성기조동평분,순배、호흡、혈양포화도변화급부작용.결과 술후소성기조동평분F조、K조화T조명현저우C조.술후0hF조、K조、T조시각모의(VAS)평분화개량목적평분법(MOPS평분)분별위(0.6±1.0)화(0.8±1.0)、(1.9±1.9)화(1.8±1.7)、(0.8±1.4)화(0.8±1.3),균명현저우C조적(3.7±1.7)화(3.5±1.5)(P＜0.01)；F조VAS평분재술후8h위(0.9±1.0)현저저우K조(1.8±1.7)、T조(1.8±0.7)화C조(1.7±0.7)(P＜0.01)；F조MOPS평분위(0.3±0.7)재술후8h저우C조(0.7±0.6)(P＜0.05)；F조화T조VAS평분재술후0h저우K조(P＜0.05).4조술후각개시점적순배、호흡、혈양포화도변화균재정상범위,F조혈압재술후0h현저저우K조、T조화C조,조간비교차이유통계학의의(P＜0.01).4조균무심률실상、호흡억제、응혈공능이상발생,악심、구토、두훈、번조、주악몽、복통등부작용발생솔4조지간차이무통계학의의(P＞0.05).술후수면불가발생솔C조고우F조(P＜0.05).결론 불비락분지、록알동、곡마다균능유효감소소성기조동,단록알동、곡마다균미현시초전진통효과,불비락분지초전진통효과량호,작용시간장,능유효완해소인단소수술적술후동통,무명현부작용,가안전용우소인단소수술적술후진통.
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.
