张英传

摘 要 目的：观察酮咯酸氨丁三醇用于小儿瑞芬太尼全麻下鼾症手术的临床效果。方法：选取择期行鼾症手术的患儿90例，随机分为对照组和观察组各45例。手术结束前30 min，对照组静脉注射生理盐水1 ml，观察组静脉注射酮咯酸氨丁三醇0.5 mg/kg。比较两组术后各时间点的平均动脉压、心率、苏醒时间、按指令咳嗽时间、拔管时间、VAS评分以及躁动评分。结果：观察组各时间点平均动脉压、心率、术后VAS评分及躁动评分低于对照组（P<0.05）；两组苏醒时间、按指令咳嗽时间、拔管时间差异无统计学意义（P>0.05）。结论：酮咯酸氨丁三醇用于小儿鼾症手术可以有效减少术后疼痛及躁动，血流动力学平稳，且不影响清醒时间和拔管时间，不增加呼吸抑制。

关键词 酮咯酸氨丁三醇 瑞芬太尼 小儿鼾症手术 术后疼痛及躁动

中图分类号：R971.1； R726.5 文献标志码：B 文章编号：1006-1533（2021）09-0031-02

Observation of ketorolac tromethamine used in pediatric snoring surgery under general anesthesia with remifentanil

ZHANG Yingchuan

（Department of Anesthesiology， Traditional Chinese Medicine Hospital of Wuqing District， Tianjin 301700， China）

ABSTRACT Objective： To observe the clinical effect of ketorolac tromethamine in pediatric snoring surgery under general anesthesia with remifentanil. Methods： 90 children with snoring were randomly divided into an observation group and a control group with 45 cases each. The control group was given intravenous injection of 1 ml of normal saline while the observation was given intravenous ketorolac tromethamine of 0.5 mg/kg 30 minutes before the end of operation. The mean arterial pressure， the heart rate， the times for recovery， cough as directed and extubation， the VAS and agitation scores were compared between the two groups. Results： The mean arterial pressure， heart rate， VAS scores and restlessness scores were significantly lower in the observation group than the control group （P<0.05）， and there were no significant differences between the two groups in the times for recovery， cough as directed and extubation （P>0.05）. Conclusion： Ketorolac tromethamine for pediatric snoring surgery can effectively reduce postoperative pain and restlessness， has stable hemodynamics and can not affect the times for awake and extubation and increase respiratory inhibition neither.

KEy WORDS ketorolac tromethamine； remifentanil； pediatric snoring surgery； postoperative pain and agitation

小兒鼾症手术在临床比较常见，由于小儿的生理解剖特点与成年人之间有着极大的不同，且小儿自控能力差，因此对存在耳鼻喉疾病的患儿进行手术时为了达理想的镇痛效果，且不对患儿的呼吸产生抑制的目的，需要对患儿实施优质的麻醉措施[1]。临床麻醉中多采用短效、高效的麻醉药物，瑞芬太尼起效快，作用时间短，临床中常被运用，但极易导致患儿苏醒期出现乱动哭闹、安抚困难、挣扎、定向障碍、躁动等行为[2]。临床上常采用阿片类或镇静药物来预防或解决。然而，阿片类药物和镇静药物往往会带来一系列不良反应，如苏醒期延长、恶心、呕吐、呼吸抑制等。酮咯酸氨丁三醇是一种非甾体类抗炎药，临床麻醉中可用于治疗术中、术后疼痛。……