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瑞芬太尼与芬太尼对儿童扁桃体切除术后苏醒及恶心呕吐的影响
Influence of fentanyl or remifentanil anesthesia on postoperative emergence and nausea and vomiting in patients undergoing tonsillectomy

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DOI:
作者:
叶国妹，胡瑶琴， 胡智勇
Ye Guo-mei,Hu Yao-qin,Hu Zhi-yong
作者单位:
浙江大学医学院附属儿童医院麻醉科
Department of anesthesia, Children’s hospital affiliated to Zhejiang university school of medicine
关键词:
瑞芬太尼；芬太尼；扁桃体切除术
Remifentanil; Fentanyl; tonsillectomy
摘要:
目的 比较术中应用瑞芬太尼或芬太尼复合异丙酚麻醉对扁桃体切除术儿童苏醒及术后呕吐发生率的影响。方法 择期全麻下扁桃体切除术病儿60例，随机分成2组（n = 30）。诱导用咪唑安定、氯胺酮、异丙酚、维罗库溴铵和芬太尼(5µg/kg)或瑞芬太尼(2µg/kg)镇痛。气管插管后用异丙酚或异丙酚复合瑞芬太尼维持麻醉、空气-氧气混合吸入。术毕拔管时按需给予纳洛酮、新斯的明拮抗。记录两组患儿的拔管时间及需要纳洛酮拮抗的人数。若术后30min内患儿恶心呕吐≥2次则静脉给予盐酸昂丹司琼4mg，分别记录术后2、 2、24小时发生恶心呕吐和需要胃复安的病人数， P<0.05认为有显著意义。结果 两组病儿ASA 分级、异丙酚剂量、血液动力学等方面差异无显著性。瑞芬太尼组拔管时间及需要纳洛酮拮抗的人数均明显少于芬太尼组（P<0.05），瑞芬太尼组术后0、2、12小时恶心呕吐的发生率明显低于芬太尼组（P<0.05）。结论 与芬太尼相比，在扁桃体切除手术中，瑞芬太尼镇痛可以促进术后苏醒及减少术后恶心呕吐的发生率。
Objective To compare the postoperative emergence and the incidence of postoperative nausea and vomiting (PONV) after fentanyl-propofol or remifentanil- propofol anesthesia in patients undergoing tonsillectomy. Methods Sixty ASA I or II patients scheduled for tonsillectomy divided into two groups randomizedly (n = 30). Anaesthesia was induced with midazalem, katamine, propofol, norcorum and fentanyl (5µg/kg) or remifentanil (2µg/kg). After tracheal intubation, anaesthesia was maintained with propofol, oxygen in air and remifantanil infusion, which was modified according to clinical criteria. Nerocom and neostigmine was administrated if necessary. The time of tracheal extubation and the number of patients using nerocom. Ondansetron was administered if a patient presented 2 or more times of PONV episodes (nausea or vomiting) in 30 min. The numbers of patients with episodes of PONV and requiring metoclopramide were recorded on 2, 12 and 24 h postoperative,. P < 0.05 was considered significant. Results There were no significant difference between groups in the hemodynamics, ASA status, and propofol doses. Both the time to tracheal extubation and the number of requiring the nerocum are less in the remifentanil group than in fentanyl group(P < 0.05). The number of postoperative PONV episodes was less in the 12h period in remifentanil group than fentanyl group(P < 0.05). Conclusion Remifentanil anaesthesia fastened the postoperative recovery and reduce the incidence of PONV and less requirements of antiemetic drugs than fentanyl anaesthesia in the period between 0 to 12 postoperative hours in patients undergoing tonsil surgery.

 

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