【摘要】 目的:探讨术毕前应用地佐辛对急腹症患儿全麻苏醒期寒战和躁动的治疗作用和安全性。方法:拟行剖腹探查阑尾切除术患儿120例,ASAⅡ^Ⅲ级、年龄3⁷岁,其中男68例,女52例,体重13³5 kg。采用随机数字表法将患儿分为地佐辛组（D组）、曲马多组（T组）和生理盐水组（C组）,每组40例。入手术室静脉注射依托咪酯0.3mg/kg,咪达唑仑0.1 mg/kg,苯磺顺阿曲库铵0.15 mg/kg和舒芬太尼0.4μg/kg后行气管插管,术中持续静脉泵注丙泊酚0.1⁰.15 mg·kg^-1·min^-1、瑞芬太尼0.4μg·kg^-1·min^-1、间断静脉注射苯磺顺阿曲库铵0.05 mg/kg维持麻醉。手术结束前20 min,D组静脉注射生理盐水稀释至3 mL的地佐辛0.1 mg/kg,T组静脉注射生理盐水稀释至3mL的曲马多1 mg/kg,C组静脉注射生理盐水3 mL。记录三组患者一般资料、手术时间、麻醉时间、自主呼吸恢复时间、拔管时间;拔管后寒战发生情况及程度,躁动评分及发生率;术后24 h恶心、呕吐、嗜睡、呼吸抑制、皮肤瘙痒等不良反应发生情况。结果:三组患儿年龄、体重、性别构成比、手术时间和麻醉时间比较,差异无统计学意义（P>0.05）。三组患儿术后自主呼吸恢复时间、拔管时间比较,差异无统计学意义（P>0.05）;与C组相比,D组与T组患儿麻醉苏醒期躁动评分与躁动发生率降低（P<0.05）;与C组相比,D组与T组患儿麻醉苏醒期寒战发生率明显降低（P<0.05）;与T组比较,D组恶心、呕吐发生率明显降低（P<0.05）,三组患儿术后24 h无呼吸抑制发生,嗜睡及皮肤瘙痒不良反应发生率比较,差异无统计学意义。结论:急腹症患儿手术结束前使用地佐辛可以显著减少麻醉恢复期寒战和躁动的发生率,且术后苏醒迅速、平稳,不良反应少。更多还原

【Abstract】 Objective:To explore the therapeutic effect and safety of dezocine used before end of operation on shivering and emergence agitation（EA） during general anesthesia recovery period in children with acute abdominal pain.Methods:All120（male 68,female 52）ASA Ⅱ^Ⅲ children,aged 3 ⁷ year,weighing 13 ³5 kg,appendectomy surgery,were randomized into 3 groups:dezocine group（Group D）,tramadol group（Group T） and control group（Group C）.Anesthesia was induced with iv injection of etomidate 0.3 mg/kg,midazlam 0.1 mg/kg,atracurium 0.15 mg/kg and sufentanil 0.4 μg/kg,and then intubated,maintained with infusion of propofol at 0.1 ⁰.15 mg ·kg^-1·min^-1.remifentanil at 0.4,and intermittent iv injection of atracurium 0.05 mg/kg.20 min before the end of operation,Group D received dezocine 0.1 mg/kg（diluted with saline to 3 mL）.Group T received tramadol 1 mg/kg（diluted with saline to 3 mL） and Group C received saline 3 mL.Patient’s normal information,surgery time,anesthesia time,spontaneously breathing recovery time were recorded.The degree and intensity of shivering after extubation.Agitation score and ratio of postoperativa agitation were recorded.The compbcations such as postoperative nausea and vomiting,drowsiness,respiratory depression and itchy skin were recorded with-in 24 h after operation.Results;There’s no significance in children’s age,weight,gender proportion,surgery time,anesthesia time（P>0.05）.There’s no significance in children’s spontaneously breathing recovery time and extubation time（P>0.05）.Compared with Group C,the incidence of pediatric anesthesia emergence delirium scale and agitation incidence rate were significantly decreased in group D and T（P <0.05）.Compared with group C,the incidence of chills in group D and group T was significantly lower than that in group C（P < 0.05） Compared with Group T,the incidence of postoperative nausea and vomiting decreased significantly in group D（P < 0.05）.There is no respiratory depression in three groups with-in 24 h after operation,the incidence of drowsiness and itchy skin has no significant difference.Conclusion;Dezocine’s use before the end of surgery can significantly reduce the incidence of agitation and shivering,children can wake up quickly,smoothly and have rare adverse reaction.更多还原