咪达唑仑滴鼻联合酮咯酸氨丁三醇超前镇痛对小儿麻醉效果的影响(1)
[摘要] 目的 探讨咪达唑仑滴鼻联合酮咯酸氨丁三醇超前镇痛对小儿麻醉效果的影响。 方法 选择2014年1～9月于山东省青岛市市立医院择期行扁桃体和腺样体切除术患儿60例，ASA分级Ⅰ级或Ⅱ级。采用随机数字表法将其分为两组：对照组(C组)和试验组(M组)，每组各30例。麻醉诱导前30 min，M组给予咪达唑仑0.2 mg/kg滴鼻，C组给予等容量生理盐水。麻醉诱导前10 min，M组静脉注射酮咯酸氨丁三醇0.5 mg/kg(最大剂量不超过15 mg)，C组静脉滴注等容量生理盐水。麻醉诱导：两组均静脉注射芬太尼3 μg/kg、丙泊酚2 mg/kg、维库溴铵0.1 mg/kg。气管插管后机械通气，吸入七氟烷维持麻醉。记录患儿入室镇静情绪评分、面罩接受程度、手术时间及苏醒时间；分别于入室时(T0)、拔除管时(T1)、拔管后5 min(T2)、拔管后10 min(T3)、拔管后30 min(T4)和拔管后1 h(T5)记录患者的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)以及T1～T5时FLACC评分、PAED评分和Ramsay评分，并观察恶心呕吐、低氧血症、呼吸抑制等不良反应发生情况。 结果 与T0比较，C组在T1～T5时MAP升高；与C组比较，M组术前镇静满意率和诱导面罩接受率升高，在T1～T5时HR和FLACC评分降低，在T1～T4时MAP和PAED评分降低，Ramsay评分升高；差异均有统计学意义(P < 0.05)。 结论 小儿麻醉诱导前咪达唑仑0.2 mg/kg滴鼻联合酮咯酸氨丁三醇0.5 mg/kg超前镇痛可获得良好的镇静作用和安全有效的镇痛效果，且能显著减少苏醒期躁动的发生。
[关键词] 咪达唑仑；酮咯酸氨丁三醇；超前镇痛；苏醒期躁动
[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210(2016)09(a)-0100-04
Anesthesiology， Qingdao Municipal Clinical Anaesthesia and Pain Quality Control Center， Shandong Province， Qingdao 266011， China
[Abstract] Objective To evaluate the influence of intranasal Midazolam combined with the preemptive analgesia with Ketorolac Tromethamine on the analgesia effect in pediatric patients. Methods Sixty ASAⅠorⅡ patients scheduled for elective tonsillectomy and adenoidectomy in Qingdao Municipal Hospital from January to September 2014 were randomized into two groups： control group (group C) and the experimental group (group M)， with 30 cases in each group. Midazolam 0.2 mg/kg were given intranasally at 30 min before anesthesia induction in group M， while the equal volume of normal saline was given intranasally in group C. 10 min before intubation pediatric， patients in group M were given Ketorolac Tromethamine 0.5 mg/kg (maximum dose less than 15 mg) intravenous injection， while patients in group C were received the equal volume of normal saline intravenous injection. Anesthesia was induced with Fentanyl 3 μg/kg， Propofol 2 mg/kg， and Vecuronium 0.1 mg/kg intravenous injection. After the routine anesthesia induction， endotracheal intubation was performed， and patients were mechanically ventilated. Anesthesia was maintained with Sevoflurane. The sedation scores and the mask acceptance rate after admission to operating room， the time of operation and wake-up were recorded. The heart rate (HR)， mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) were recorded after admission to operating room (T0)， immediately after removing tube (T1)， 5 min after extubation (T2)，10 min after extubation (T3)， 30 min after extubation (T4) and 60 min after extubation (T5). The FLACC score， PAED score and Ramsay score were recorded from T1 to T5. Adverse reactions were evaluated， such as the nausea and vomiting， hypoxemia and respiratory depression. Results Compared with T0， the MAP elevated at T1-T5 in group C； compared with group C， the satisfactory rate of preanesthesia sedation and the mask acceptance rate were higher in group M， the HR and the FLACC score reduced significantly at T1-T4， the MAP and PAED score decreased significantly， while the Ramsay score elevated significantly at T1-T4，； the differences were statistically significant (P < 0.05). Conclusion The application that Midazolam 0.2 mg/kg intranasally combined with the preemptive analgesia Ketorolac Tromethamine 0.5 mg/kg before the induction of general anesthesia， not only can obtain better sedation and significant analgesic effect， but also significantly reduce the agitation during recovery period. (王奕皓 帅训军 程绍波 李会 范金鑫 )
[关键词] 咪达唑仑；酮咯酸氨丁三醇；超前镇痛；苏醒期躁动
[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210(2016)09(a)-0100-04
Anesthesiology， Qingdao Municipal Clinical Anaesthesia and Pain Quality Control Center， Shandong Province， Qingdao 266011， China
[Abstract] Objective To evaluate the influence of intranasal Midazolam combined with the preemptive analgesia with Ketorolac Tromethamine on the analgesia effect in pediatric patients. Methods Sixty ASAⅠorⅡ patients scheduled for elective tonsillectomy and adenoidectomy in Qingdao Municipal Hospital from January to September 2014 were randomized into two groups： control group (group C) and the experimental group (group M)， with 30 cases in each group. Midazolam 0.2 mg/kg were given intranasally at 30 min before anesthesia induction in group M， while the equal volume of normal saline was given intranasally in group C. 10 min before intubation pediatric， patients in group M were given Ketorolac Tromethamine 0.5 mg/kg (maximum dose less than 15 mg) intravenous injection， while patients in group C were received the equal volume of normal saline intravenous injection. Anesthesia was induced with Fentanyl 3 μg/kg， Propofol 2 mg/kg， and Vecuronium 0.1 mg/kg intravenous injection. After the routine anesthesia induction， endotracheal intubation was performed， and patients were mechanically ventilated. Anesthesia was maintained with Sevoflurane. The sedation scores and the mask acceptance rate after admission to operating room， the time of operation and wake-up were recorded. The heart rate (HR)， mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) were recorded after admission to operating room (T0)， immediately after removing tube (T1)， 5 min after extubation (T2)，10 min after extubation (T3)， 30 min after extubation (T4) and 60 min after extubation (T5). The FLACC score， PAED score and Ramsay score were recorded from T1 to T5. Adverse reactions were evaluated， such as the nausea and vomiting， hypoxemia and respiratory depression. Results Compared with T0， the MAP elevated at T1-T5 in group C； compared with group C， the satisfactory rate of preanesthesia sedation and the mask acceptance rate were higher in group M， the HR and the FLACC score reduced significantly at T1-T4， the MAP and PAED score decreased significantly， while the Ramsay score elevated significantly at T1-T4，； the differences were statistically significant (P < 0.05). Conclusion The application that Midazolam 0.2 mg/kg intranasally combined with the preemptive analgesia Ketorolac Tromethamine 0.5 mg/kg before the induction of general anesthesia， not only can obtain better sedation and significant analgesic effect， but also significantly reduce the agitation during recovery period. (王奕皓 帅训军 程绍波 李会 范金鑫 )