CAJ | 학술논문

目的：观察术毕前15min静注舒芬太尼对腭裂整复术患儿术后苏醒期躁动的预防效果。方法80例择期全麻下行腭裂整复术腭裂患儿随机分为A、B、C、D组各20例，各组均采用瑞芬太尼、丙泊酚全凭静脉麻醉，术毕前15 min分别静注舒芬太尼（A组0．10μg／kg，B组0．15μg／kg，C组0．20μg／kg），D组静注生理盐水2 mL。记录各组呼吸恢复时间、拔管时间、苏醒时间（停药至呼之睁眼的时间）、离麻醉后监测治疗室（ PACU）时间，观察拔管时（ T1）、苏醒时（T2）、离PACU时（T3）的平均动脉压（MAP）、心率（HR）及并发症发生情况，使用国际通用的小儿苏醒期躁动（PAED）评分评价苏醒期躁动情况。结果与A组比较，B、C组PAED评分减少（P均＜0．05）；与D组比较，A、B、C组PAED评分减少（P均＜0．05）。与C组比较，A、B、D组拔管、苏醒、离PACU时间短（P均＜0．05）。与A组比较， B、C组T2、T3时点MAP、HR水平降低（P均＜0．05）；与D组比较，A、B、C组T2、T3时点MAP、HR水平降低（P均＜0．05）。 A组发生低氧血症2例、上呼吸道梗阻4例、恶心呕吐0例、渗血0例，B组分别为0、1、0、2例，C组分别为0、0、0、2例，D组分别为1、1、1、6例，各组比较，P均＞0．05。结论对于小儿腭裂手术，术毕前15 min静注0．15μg／kg舒芬太尼，可在不延长苏醒及离PACU时间的同时有效预防苏醒期躁动，保持苏醒期心血管系统稳定。
목적：관찰술필전15min정주서분태니대악렬정복술환인술후소성기조동적예방효과。방법80례택기전마하행악렬정복술악렬환인수궤분위A、B、C、D조각20례，각조균채용서분태니、병박분전빙정맥마취，술필전15 min분별정주서분태니（A조0．10μg／kg，B조0．15μg／kg，C조0．20μg／kg），D조정주생리염수2 mL。기록각조호흡회복시간、발관시간、소성시간（정약지호지정안적시간）、리마취후감측치료실（ PACU）시간，관찰발관시（ T1）、소성시（T2）、리PACU시（T3）적평균동맥압（MAP）、심솔（HR）급병발증발생정황，사용국제통용적소인소성기조동（PAED）평분평개소성기조동정황。결과여A조비교，B、C조PAED평분감소（P균＜0．05）；여D조비교，A、B、C조PAED평분감소（P균＜0．05）。여C조비교，A、B、D조발관、소성、리PACU시간단（P균＜0．05）。여A조비교， B、C조T2、T3시점MAP、HR수평강저（P균＜0．05）；여D조비교，A、B、C조T2、T3시점MAP、HR수평강저（P균＜0．05）。 A조발생저양혈증2례、상호흡도경조4례、악심구토0례、삼혈0례，B조분별위0、1、0、2례，C조분별위0、0、0、2례，D조분별위1、1、1、6례，각조비교，P균＞0．05。결론대우소인악렬수술，술필전15 min정주0．15μg／kg서분태니，가재불연장소성급리PACU시간적동시유효예방소성기조동，보지소성기심혈관계통은정。
Objective To observe the preventive efficiency of intravenous injection of sufentanil 15 minutes before com-pletion of surgery on emergence agitation in children undergoing cleft palate repair.Methods Eighty children undergoing cleft palate repair were randomly divided into four groups, 20 cases in each group:sufentanil groups ( groups A, B and C) and the control group ( group D) .After venous induction, the general anesthesia was maintained with remifentanil and propo-fol.About 15 minutes before completion of surgery, groups A, B and C were respectively administrated with intravenously sufentanil at dose of 0.10μg/kɡ, 0.15μg/kɡand 0.20μg/kɡ.Group D was intravenously injected with normal saline.Pe-diatric anesthesia emergence delirium ( PAED) scale was used to evaluate the emergence agitation, and the respiration recov-ery time, time of tracheal extubation, recovery time, time of leaving postanesthesia care unit ( PACU) were recorded.Mean-while, mean arterial pressure ( MAP) and heart rate ( HR) were recorded at time points of tracheal extubation ( T1 ) , being awake ( T2 ) and leaving PACU ( T3 ) , respectively.Results Compared with group A, PAED scores in the groups B and D were decreased (all P<0.05);compared with group D, PAED scores in the groups A, B and C were decreased (all P<0.05).Compared with group C, the time of tracheal extubation, recovery time and time of leaving PACU was significantly shortened in the groups A, B and D (all P<0.05).Compared with group A, the MAP and HR at T2 and T3 were significant-ly decreased in the groups B and C (all P<0.05);Compared with group D, the MAP and HR at T2 and T3 were significantly decreased in the groups A, B and C (all P<0.05).In the group A, there were 2 cases of hyoxemia, 4 cases of upper respir-atory tract obstruction, no nausea, vomiting or exudation;they were respectively 1, 0, 0 and 2 cases in the group B;0, 0, 0 and 2 cases in the group C;and 1, 1, 1 and 6 cases in the group D.No significant difference was found among these four groups (all P>0.05).Conclusion The administration of sufentanil 0.15μ/kɡabout 15 minutes before completion of sur-gery in children undergoing palate repair can effectively prevent the emergence agitation without prolonging the recovery time and leaving PACU time and maintain the cardiovascular system stable in the recovery period.