刘东志 赵志斌

[摘要]目的 探討地佐辛对患儿腹腔镜手术苏醒期躁动（PAED）的影响。方法 选取连云港市第一人民医院2016年4月～2017年11月择期行腹腔镜疝囊高位结扎手术的患儿60例，将其随机分为地佐辛组（n=30）和对照组（n=30）。手术结束前15 min，地佐辛组患儿注射地佐辛0.1 m/kg，对照组患儿注射等体积的生理盐水。观察并记录患儿的手术时间、拔管时间、入麻醉后监护治疗室（PACU）时改良Aldrete 评分和PACU 滞留时间；记录患儿入室时（T0）、停药时（T1）、拔管时（T2）、拔管后5 min（T3）的平均动脉压（MAP）和心率（HR）；同时记录拔管后30 min内PAED评分、改良东安大略儿童医院疼痛评分（m-CHEOPS）及不良反应发生情况。结果 地佐辛组患儿的PAED 评分、m-CHEOPS 评分均低于对照组（P<0.001）；两组患儿的拔管时间、入 PACU 时改良 Aldrete 评分及 PACU 滞留时间比较，差异无统计学意义（P>0.05）。地佐辛组患儿的MAP、HR在T2、T3时均低于同时间点对照组（P<0.05）。两组患儿均未见不良反应。结论 腹腔镜疝囊高位结扎术患儿手术结束前15 min静注地佐辛0.1 mg/kg可以减少全身麻醉PAED的发生，不延长患儿术后苏醒及拔管时间，患儿血流动力学平稳，且无不良反应。

[关键词]地佐辛；小儿；全身麻醉；腹腔镜；苏醒期躁动

[中图分类号] R614.2+4 [文献标识码] A [文章编号] 1674-4721（2018）5（b）-0017-04

Influence of Dezocine on emergence agitation of surgical anesthesiain in children given laparoscopic surgery

LIU Dong-zhi ZHAO Zhi-bin

Department of Anesthesiology，the First People′s Hospital of Lianyungang City，Jiangsu Province，Lianyungang 222002，China

[Abstract]Objective To explore the influence of Dezocine on emergence agitation of surgical anesthesiain in children given laparoscopic surgery.Methods 60 children scheduled for laparoscopic high ligation of hernia sac treated in the First People′s Hospital of Lianyungang from April 2016 to November 2017 were selected and they were randomly divided into the Dezocine group （n=30） and control group （n=30）.15 min before the end of operation，Dezocine group was given 0.1 mg/kg Dezocine，while the control group was given the same volume of normal saline.The operation time，extubation time and modified Aldrete score when entered into the post-anesthesia care unit （PACU） and PACU retention time were observed and recorded.Mean arterial pressure （MAP） and heart rate （HR） were recorded at the time before anesthesia （T0），drug withdrawal （T1），extubation （T2） and 5 min after extubation （T3）.At the same time，pediatric anesthesia emergence delirium （PAED） score，modified children′s hospital of Eastern Ontario Pain Scale （m-CHEOPS） score and the incidence of adverse reactions were recorded.Results PAED score and m-CHEOPS score in the Dezocine group were lower than those in the control group （P<0.001）.There were no significant difference in the extubation time，the modified Aldrete score or PACU retention time between the two groups （P>0.05）.MAP and HR of the Dezocine group were lower than those of the control group at T1 and T2 （P<0.05）. The HR of Dezocine group was slower than that of the control group at T2 and T3 （P<0.05）.Adverse reactions were not found in the two groups.Conclusion Intravenous infusion of 0.1 mg/kg Dezocine before the end of operation in children′s laparoscopic high ligation of hernia sac can prevent the incidence of emergence agitation after general anesthesia but don′t prolong the postoperative recovery and extubation time in children.The hemodynamics was stable and adverse reactions were not observed in children.

[Key words]Dezocine；Children；General anesthesia；Laparoscopic surgery；Emergence agitation

腹腔镜手术具备损伤小、康复快、并发症少等优势，近年被广泛应用于小儿外科手术。瑞芬太尼复合七氟醚现已广泛应用于小儿腹腔镜手术的麻醉，具有麻醉平稳、镇痛效果确切及苏醒彻底等优点[1-2]。但苏醒期躁动（PAED）的发生率较高，且可能会导致严重的不良反应[3]。地佐辛是一种较新型的阿片类受体激动拮抗药，具有镇痛作用强及轻度镇静作用，近来被越来越多地应用于全身麻醉及术后镇痛[4-5]。本研究拟探讨地佐辛对患儿腹腔镜手术麻醉苏醒期躁动的影响。

1资料与方法

1.1 一般资料

选取连云港市第一人民医院2016年4月～2017年11月符合纳入标准择期行腹腔镜疝囊高位结扎手术的患儿60例，男36例，女24例，将其随机分为地佐辛组（n=30）和对照组（n=30）。……