地佐辛对小儿腹腔镜阑尾术后苏醒及镇痛的影响

Impact of Dezocine on anesthesia recovery and postoperative pain in children receiving laparoscopic appendectomy

摘要:

目的 观察术毕前应用地佐辛对小儿腹腔镜阑尾术后苏醒的影响、术后疼痛的干预效果及安全性。方法 腹腔镜阑尾切除术患儿60例，美国麻醉医师协会分级（ASA）Ⅰ或Ⅱ级，4～10岁，随机分为D、F、N 3组，每组20例。3组均采用瑞芬太尼复合丙泊酚、七氟醚静吸复合全身麻醉，术毕前30 min D组静脉注射地佐辛0.10 mg/kg，F组静脉注射芬太尼1.0μg/kg，N组给予等剂量生理盐水。术毕前5 min停用麻醉药，术毕待患儿呼之睁眼，自主呼吸恢复满意后拔管。观察并记录停药时、拔管时及拔管后5 min的动脉血氧饱和度（SpO2）、平均动脉压（MAP）、心率（HR）及呼吸次数（RR）；记录拔管时间、拔管后30 min内苏醒期Riker镇静躁动评分及儿童行为量表疼痛程度（FLACC）评分及不良反应的发生情况。结果 拔管时和拔管后5 min N组和F组的MAP及HR均高于D组，差异有统计学意义（P <0.05）；F组和N组拔管时和拔管后5 min的MAP及HR均较停药时明显升高（P <0.05）。D组在各时间点SpO2、MAP、HR及RR前后变化比较，差异无统计学意义（P >0.05）；D组在拔管后30 min内苏醒期Riker镇静躁动评分及FLACC评分均较F组和N组低（P <0.05）。3组患儿在拔管后30 min内均未见呼吸、循环抑制、恶心、呕吐、嗜睡和头痛等不良反应。结论 小儿腹腔镜手术结束前静脉应用地佐辛0.10 mg/kg，苏醒迅速平稳，血流动力学变化较小，且能减少苏醒期躁动和术后疼痛。

Abstract:

Objective To observe the impact of Dezocine used before end of operation on postoperative recovery and safety effect on postoperative pain in children receiving laparoscopic appendectomy. Methods 60 ASAⅠ ～ Ⅱ cases of aged 4～10 yr, underwent laparoscopic appendectomy, were randomly divided into 3 groups: Dezocine group (D group), Fentanyl group (F group) and control group (normal saline group), 20 cases in each group. Remifentanil combined with Propofol and Sevoflurane was given for conducting endotracheal intubation general anesthesia. At 30 min before the end of operation, D group was given Dezocine 0.10 mg/kg, while F group fentanyl 1.0 μg/kg, and the control group was given same volume of normal saline. 5 min before the end of the operation anesthetics disabled, then extubation until children open eyes on call and spontaneous breathing recovered satisfactorily. Observe and record MAP, HR, SPO2 and respiration rate (RR) at different times: drug withdrawal, extubation and 5 min after extubation, while also record extubation time, Riker sedation-agitation scores and face, legs, activity, cry and consolability (FLACC) scores and adverse reactions in the recovery period (within 30 min after extubation). Results MAP and HR at extubation and 5 min after extubation in N group and F group were higher than that in D group (P < 0.05); Compared with drug withdrawal time, HR and MAP at extubation and 5 min after extubation in group F and N were much higher (P < 0.05); MAP, HR, SPO2 and RR had no statistically significant difference in D group at each time point (P > 0.05). The Riker sedation-agitation scores and the FLACC scores at 30 min after extubation in D group were significantly lower than those in the F and N groups (P < 0.05), adverse reaction such as respiratory inhibition, nausea, vomiting, lethargy, headache were not found in the 3 groups. Conclusion Intravenous Dezocine before the end of operation in children's laparoscopic operation can make awake quickly and smoothly, allow small hemodynamic changes, and can reduce postoperative pain and restlessness.