应用纳美芬与纳洛酮对新生儿腹腔镜幽门环切术后苏醒的作用研究

Comparison of Nalmefene and Naloxone on postoperative recovery for neonates by laparoscopic pyloromyotomy

摘要:

目的 观察纳美芬对新生儿腹腔镜幽门环切术后苏醒的临床效果。方法 择期气管插管吸入麻 醉下腹腔镜幽门环切术新生儿60 例，年龄15 ～ 28 d，美国麻醉医师协会（ASA）Ⅱ～Ⅲ级，随机分为纳美芬 组（M 组）和纳洛酮组（L 组），每组30 例。手术结束时M 组静脉注射纳美芬0.25μg/kg，L 组静脉注射纳 洛酮1.00μg/kg。并记录静脉注射纳美芬或纳洛酮前（T0）、给药后10 min（T1）、拔管后30 min（T2）和拔管 后2 h（T3）的脉搏血氧饱和度（SpO2）、平均动脉压（MAP）、心率（HR）和呼吸频率（RR）；记录自主呼 吸恢复时间、拔管时间、麻醉后监测治疗室（PACU）停留时间及手术结束后24 h 内不良反应（如呼吸抑制、 恶心呕吐、嗜睡和躁动等）。结果 两组在T0、T1、T2 和T3 时点，SpO2、MAP 和HR 比较均差异无统计学 意义（P >0.05），两组患儿T1、T2 和T3 时的RR，均较T0 时明显升高（P <0.05），且T1 时，M 组RR 明显快 于L 组（P <0.05）。M 组患儿自主呼吸恢复时间、拔管时间和PACU 停留时间差均明显短于L 组（P <0.05）。 术后不良反应差异无统计学意义。结论 纳美芬在合理剂量范围内，有助于新生儿腹腔镜幽门环切术后早期 苏醒。和纳络酮相比，可有效缩短拔管时间，促进早期恢复。

Abstract:

Objective To observe the effect of Nalmefene on postoperative recovery on neonates by laparoscopic pyloromyotomy. Methods Elective laparoscopic pyloromyotomy for 60 neonates under general anestheisa, aged 15 ~ 28 days, ASA Ⅱ～Ⅲ , were randomly divided into two groups: Nalmefene group (M group) and Naloxone group (L group), 30 cases in each. Nalmefene 0.25 μg/kg and Naloxone 1.00 μg/kg were respectively administrated in M group and L group when the procedures finished. Parameters SpO2, MAP, HR and RR were measured and analyzed statistically at different times: end of surgery before drugs were used (T0), 10 min after administration (T1), 30 mins after extubation (T2) and 2 h after extubation (T3). Meanwhile observing spontaneous breathing recovery time, extubation time, residence time at PACU and adverse events 24 s after surgery. Results There were no actual differences in the value of MAP, HR and SpO2 at T0, T1, T2 and T3 times in the two groups (P > 0.05). However, the values of RR was significant faster at T1, T2 and T3 times than that at T0 in both groups (P < 0.05), compared with L group, the value of RR at T1 was much faster in M group (P < 0.05). The times of extubation and residence at PACU have significant differences in M group than that in L group (P < 0.05). The adverse events in both groups have no differences. Conclusion Nalmefene can facilitate the recovery at laparoscopic pyloromyotomy on neonates. Compared with naloxone, it can reduce the extubation time, and promote the early rehabilitation.