CAJ | 학술논문

目的观察联合应用芬太尼、对乙酰氨基酚栓剂及局部浸润麻醉对唇腭裂修补术小儿全麻苏醒期镇静镇痛的效果.方法择期行唇腭裂修补术的患儿54例,随机分为2组,对照组(C组,n=28)和多模式镇痛组(M组,n=26).均采用全身麻醉气管插管的方法,七氟烷麻醉诱导与维持.手术开始前由术者对两组患儿行局部浸润麻醉;M组患儿气管插管后即予对乙酰氨基酚栓剂塞肛;手术结束前10 min,静脉注射静脉注射芬太尼0.5μg/kg,C组不给药.观察两组患儿停止吸入七氟烷至拔除气管导管的时间、PACU内镇静镇痛评分、PACU的滞留时间及不良反应的发生情况.结果两组患儿从停止吸入麻醉药至拔除气管导管时间无明显差异;PACU滞留时间M组[(25 ±4)min]较C组[(32±3)min]短(t=7.426,P<0.01);与C组比较,M组患儿镇痛满意(F=4.840,P=0.028),发生严重疼痛(F=5.333,P=0.021)及躁动(F=4.571,P=0.033)的例数少,差异具有统计学意义;两组患儿无一例发生呼吸抑制及瘙痒,过度镇静和恶心呕吐的发生率,两组间差异无统计学意义.结论联合应用芬太尼、对乙酰氨基酚栓剂及局部浸润麻醉的多模式镇痛方法在苏醒期可为唇腭裂修补术小儿提供良好的镇痛镇静,减少躁动的发生率,加快PACU患者的转运速度,有利于苏醒期安全.
목적 관찰연합응용분태니、대을선안기분전제급국부침윤마취대진악렬수보술소인전마소성기진정진통적효과.방법 택기행진악렬수보술적환인54례,수궤분위2조,대조조(C조,n=28)화다모식진통조(M조,n=26).균채용전신마취기관삽관적방법,칠불완마취유도여유지.수술개시전유술자대량조환인행국부침윤마취;M조환인기관삽관후즉여대을선안기분전제새항;수술결속전10 min,정맥주사정맥주사분태니0.5μg/kg,C조불급약.관찰량조환인정지흡입칠불완지발제기관도관적시간、PACU내진정진통평분、PACU적체류시간급불량반응적발생정황.결과 량조환인종정지흡입마취약지발제기관도관시간무명현차이;PACU체류시간M조[(25 ±4)min]교C조[(32±3)min]단(t=7.426,P<0.01);여C조비교,M조환인진통만의(F=4.840,P=0.028),발생엄중동통(F=5.333,P=0.021)급조동(F=4.571,P=0.033)적례수소,차이구유통계학의의;량조환인무일례발생호흡억제급소양,과도진정화악심구토적발생솔,량조간차이무통계학의의.결론 연합응용분태니、대을선안기분전제급국부침윤마취적다모식진통방법재소성기가위진악렬수보술소인제공량호적진통진정,감소조동적발생솔,가쾌PACU환자적전운속도,유리우소성기안전.
Objective To investigate the effects of multimodal analgesia on analgesia and sedation during emergence of general anesthesia for cleft lip and/or palate surgery pediatric patients. Methods Fifty-four pediatric patients with ASA Ⅰ and Ⅱ cleft lip and/or palate, aged 2 - 7, undergoing prosthesis were randomly allocated into 2 groups: control group (Group C, n = 28) inhaling nitrous oxide/oxygen (50%: 50%) and sevoflurane(5%) for general anesthesia, and multimodal group (Group M, n =26), injected intravenously with fentanyl and atracurium in addition to inhalation of nitrous oxide/oxygen (50%: 50%) and sevoflurane(5%). Ventilation was controlled with PCV modal to maintain end-tidal CO2 to 35 -45 mmHg. Local anesthesia at the surgical site was facilitated by the surgeon before the beginning of surgery. After intubation, rectal paracetamol was used for Group M (120 mg for 2 -4 year-olds and 325 mg for 5 -7 year-olds) and fentanyl 0. 5 μg/kg was injected for postoperative analgesia 10 rain before the end of surgery. An observer who was blinded to the protocol recorded the time from the discontinuation of sevoflurane and nitrous oxide to tracheal extubation, accessed the sedation and pain scale, recorded the time ready for discharge from post-anesthesia care unit (PACU) and the incidence of adverse effects. Results The time ready for discharge from PACU of Group M was (25 ± 4) min, significantly shorter than that of Group C [(32 ± 3) min ,t =7. 426 ,P <0. 01]. The analgesia satisfaction rate of Group M was 69.2% (18/ 26), significantly higher than that of Group C [25.0%, 7/28, P <0.05]. The severe pain rate of Group M was 7.7 %, ignificantly lower than that of Group C (35.7 %, F = 5. 333, P = 0.021). The agitation rate of Group M was 11.5%, significantly lower than that of Group C (39.3%, F = 4. 571, P = 0. 033) . Conclusion Multimodal analgesic regimen of infiltration of local anesthetic at surgical site and rectal paracetamol and intravenous fentanyl provides sufficient analgesia, minimizes the incidence of agitation after general anesthesia in cleft lip and/or palate surgery for children, increases the speed of referring patients in PACU, and ensures the safety of the postanaesthetic patients.