上海口腔医学

上海口腔医学 ›› 2021, Vol. 30 ›› Issue (6): 654-657.doi: 10.19439/j.sjos.2021.06.018

• 论著 • 上一篇    下一篇

布洛芬超前镇痛对婴幼儿腭裂术后苏醒质量的影响

彭哲哲, 孙瑛, 张马忠, 郑吉建, 王燕婷   

  1. 上海交通大学医学院附属上海儿童医学中心 麻醉科,上海 200127
  • 收稿日期:2021-05-18 修回日期:2021-08-10 发布日期:2022-03-09
  • 通讯作者: 王燕婷,E-mail：wangyanting@scmc.com.cn
  • 作者简介:彭哲哲（1991-）,女,硕士, E-mail：pengzhezhe816@163.com

Effect of ibuprofen administration for preemptive analgesia on recovery quality after palatoplasty in infants

PENG Zhe-zhe, SUN Ying, ZHANG Ma-zhong, ZHENG Ji-jian, WANG Yan-ting   

  1. Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine. Shanghai 200127, China
  • Received:2021-05-18 Revised:2021-08-10 Published:2022-03-09

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摘要： 目的: 评价布洛芬注射液对婴幼儿腭裂手术后麻醉苏醒质量的影响。方法: 将46例拟行腭裂修补术治疗的患儿,按照是否接受布洛芬注射液随机分为试验组（A组）和对照组（B组）,每组23例。采用8%七氟醚合并8 L/min氧气吸入麻醉诱导,待患儿意识消失后开放静脉,静脉注射阿托品0.01 mg/kg、芬太尼2 μg/kg、异丙酚2 mg/kg、罗库溴铵0.6 mg/kg,肌松效果满意后插入气管导管。调节七氟醚浓度,维持麻醉深度在1~2 MAC值。麻醉诱导后,A组立即静脉泵注布洛芬10 mg/kg,B组泵注等容量生理盐水,2组静脉泵注时间均设置为10 min。术毕停用七氟醚,符合拔管指征后拔出气管内导管,转运至麻醉复苏室(PACU)。记录患儿手术时间、停药至自主呼吸恢复时间与拔管时间。记录患儿入PACU即刻(T0)、10 min(T1)、20 min(T2)、30 min(T3)的FLACC疼痛评分和PAED躁动评分,对重度疼痛患儿或严重躁动持续5 min的患儿,采用芬太尼1 μg/kg缓慢注射治疗,记录围术期不良事件。采用SAS 9.1软件包进行统计学分析。结果: 2组患儿一般资料、手术时间、术毕自主呼吸恢复时间与拔管时间无显著差异（P>0.05）,2组FLACC疼痛评分在T0、T1及T2时间点差异显著(P<0.05);2组PAED躁动评分在各时间点均有显著差异（P<0.05）;A组4例患儿接受芬太尼治疗（18%）,B组9例（43%）患儿接受芬太尼治疗,差异显著（P<0.05）;B组1例患儿使用芬太尼治疗后出现SpO2<93%,持续吸氧后情况改善,未延长PACU留观时间。结论: 麻醉诱导后使用布洛芬注射液,不影响婴幼儿术毕自主呼吸恢复与拔管,可降低其PACU内疼痛与躁动水平,改善麻醉苏醒期质量。

关键词: 腭裂, 布洛芬, 婴幼儿, 镇痛

Abstract: PURPOSE: To evaluate the effect of ibuprofen injection on the quality of postoperative anesthesia for infants who received palatoplasty. METHODS: Patients were induced with 8 % sevoflurane in oxygen(8 L/min), followed by intravenous catheterization. Tracheal intubation was facilitated intravenously with atropine 0.01 mg/kg, propofol 2 mg/kg, fentanyl 2 μg/kg, and rocuronium 0.6 mg/kg. Anesthesia was maintained with 1-2 minimum alveolar concentration sevoflurane in oxygen and air until the end of surgery. Forty-six patients with cleft palate were randomly divided into ibuprofen injection group (Group A) and control group (Group B) with 23 patients in each group. Patients in group A received a single dose of 10 mg/kg ibuprofen intravenously and patients in group B received normal saline in 10 min after induction. The patients were transferred to postanesthesia care unit (PACU) after tracheal extubation. The operation time, spontaneous respiration recovery time and extubation time were recorded. FLACC score and PAED score were recorded immediately (T0), 10 min(T1), 20 min(T2), and 30 min(T3) after arrival at PACU. Fentanyl was injected slowly at 1 μg/kg for treatment of severe pain or severe delirium which lasted over 5 min. Perioperative adverse events were also recorded. Statistical analysis was performed using SAS 9.1 software. RESULTS: There was no significant difference in operation time, spontaneous respiratory recovery time and extubation time between the two groups(P>0.05), but there was significant difference in FLACC score between the two groups at T0 to T2(P<0.05). PAED score was significantly different between the two groups at all observation time point (P<0.05). Four(18%) patients in Group A and 9(43%) patients in group B received fentanyl treatment, the difference was significant(P<0.05). One patient from Group B presented SpO2<93% after treatment with fentanyl. Hypoxia was relieved after persistent oxygen therapy without prolongation of observation time in PACU. CONCLUSIONS: Injection of ibuprofen for infants after induction does not affect spontaneous respiratory recovery time and extubation time. In addition, the application contribute to pain and agitation relief in PACU without adverse events.

Key words: Cleft palate, Ibuprofen, Injection, Analgesia

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