-
麻醉后顺利苏醒对于小儿围手术期生命安全至关重要,尤其是小儿扁桃体切除术后,这一点更为关键[1]。手术结束后,患儿麻醉深度逐渐降低,但气管导管(ETT)作为一种异物的存在,会引起小儿咳嗽和躁动[2]。此外,在小儿扁桃体切除术后出现咳嗽可能会导致创面出血和喉炎,并增加疼痛和躁动,危及儿童的生命安全与健康[3]。目前各种方法和药物用以减少麻醉后出现咳嗽和躁动的发生率,其中包括深麻醉平面拔管、使用强化喉罩代替ETT、静脉或气管内注射利多卡因、静脉注射硫酸镁、氯胺酮和类阿片等药物[4-10]。低剂量丙泊酚可能有在微创手术中作为气道反射抑制剂的作用[11]。在低于麻醉剂量的浓度下,丙泊酚可以预防小儿拔管期间的喉痉挛[12]。然而鲜有研究比较丙泊酚和氯胺酮对小儿扁桃体切除术后咳嗽的影响。本研究比较小剂量氯胺酮与小剂量丙泊酚对小儿扁桃体切除术后麻醉后咳嗽的影响。现作报道。
-
2组患儿性别、年龄、身高、体质量、麻醉时间、术中输液量差异均无统计学意义(P>0.05), 麻醉结束至拔管时间P组短于K组(P < 0.05)(见表 1)。
分组 n 年龄/岁 男 女 体质量/kg 身高/cm 麻醉时间/min 麻醉结束至拔管时间/min 输液量/mL P组 45 6.64±2.54 29 16 23.96±9.99 110.42±15.74 41.08±2.99 5.7±3.02 304.11±115.02 K组 45 6.17±2.07 30 15 22.66±6.86 104.62±20.18 40.64±2.75 7.2±0.43 300.22±81.11 t — 0.96 0.05# 0.72 1.52* 0.73 3.30* 0.19 P — >0.05 >0.05 >0.05 >0.05 >0.05 < 0.05 >0.05 *示t′值;#示χ2值 表 1 2组患儿一般资料比较(x±s)
-
P组各时间段咳嗽发生率均低于K组(P < 0.01),且2组患儿均未出现重度咳嗽(见表 2)。
分组 n 咳嗽情况 T0~T1 T1~T2 T2~T3 T3~T4 T4~T5 T5~T6 P组 45 无 37 44 42 43 36 38 轻微 8 1 3 2 9 7 中度 0 0 0 0 0 0 重度 0 0 0 0 0 0 K组 45 无 7 10 15 18 20 18 轻微 24 19 20 21 15 19 中度 14 16 10 6 10 8 重度 0 0 0 0 0 0 uc — — 6.46 7.12 5.89 5.60 3.80 4.50 P — — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 表 2 2组患儿各时间段咳嗽率比较(n)
-
术后10、20、30、60 min疼痛评分P组高于K组(P < 0.01),术后2、4、8 h疼痛评分2组比较差异无统计学意义(P>0.05)(见表 3)。
分组 n 10 min 20 min 30 min 60 min 2 h 4 h 8 h K组 45 1.88±0.44 2.22±0.59 2.73±0.98 2.33±0.52 1.08±1.44 0.08±0.44 0.00±0.00 P组 45 8.26±0.49 6.64±1.88 4.24±0.77 4.62±2.83 2.91±0.92 0.24±0.44 0.00±0.00 t — 64.99 15.05* 8.13 5.34* 7.18 1.72 — P — < 0.01 < 0.01 < 0.01 < 0.01 >0.05 >0.05 — *示t′值 表 3 2组患儿各时间点疼痛评分比较(x±s;分)
-
P组出现恶心呕吐6例(13.3%),K组出现恶心呕吐17例(37.8%),P组低于K组,差异有统计学意义(χ2=7.07,P < 0.01)。
小剂量丙泊酚或氯胺酮对小儿扁桃体切除术麻醉苏醒后咳嗽的影响
Effect of the low-dose propofol or ketamine on coughing in children treated with tonsillectomy after recovery from anesthesia
-
摘要:
目的观察小剂量丙泊酚或氯胺酮对小儿扁桃体切除术麻醉后咳嗽的影响。 方法选择择期行扁桃体切除术小儿90例,ASA Ⅰ~Ⅱ级,随机分为丙泊酚组(P组),氯胺酮组(K组),各45例。2组患儿于手术结束后分别给予静脉注射小剂量丙泊酚(0.5 mg/kg)和小剂量氯胺酮(0.5 mg/kg),待患儿手术结束入监护室记录拔管后各时间段T0(拔管时)~T1(拔管后5min)、T1~ T2(拔管后10 min)、T2~ T3(拔管后15 min)、T3~ T4(拔管后20 min)、T4~ T5(拔管后25 min)、T5~ T6(拔管后30 min)咳嗽的发生率。分别于术后10、20、30、60 min以及2、4、8 h时间点记录术后疼痛评分,并记录患儿术后恶心呕吐的发生率。 结果P组各时间段咳嗽发生率均低于K组,术后10、20、30、60 min时间点疼痛评分均高于K组,术后恶心呕吐发生率低于K组,差异均有统计学意义(P < 0.05~P < 0.01)。 结论对于进行扁桃体切除术的儿童,在麻醉结束后静脉注射0.5 mg/kg的低剂量丙泊酚较注射0.5 mg/kg的低剂量氯胺酮能更有效地降低麻醉后咳嗽、恶心呕吐的发生率,但镇痛效果不如氯胺酮。 Abstract:ObjectiveTo observe the effects of low dose propofol or ketamine on cough in children treated with tonsillectomy after recovery from anesthesia. MethodsNinety ASA Ⅰ-Ⅱ patients scheduled by tonsillectomy were randomly divided into the propofol group(group P) and ketamine group(group K)(45 cases each group).The group P and group K were intravenously injected with low dose propofol(0.5 mg/kg) and ketamine(0.5 mg/kg) at the end of anesthesia, respectively.After the operation, the occurrence rates of cough in two groups were recorded at T0, T0-T1, T1-T2, T2-T3, T3-T4, T4-T5 and T5-T6[T0(at the time of extubation), T1(after 5 min of extubation), T2(after 10 min of extubation), T3(after 15 min of extubation), T4(after 20 min of extubation), T5(after 25 min of extubation) and T6(after 30 min of extubation)].The pain scores in two groups were recorded after 10 min, 20 min, 30 min, 1 h, 2 h, 4 h and 8 h of operation, respectively.The incidence rate of postoperative vomiting in two groups were recorded. ResultsThe incidence rates of cough in group P at each time-point were lower than that in group K, the pain scores in group P after 10 min 20 min 30 min of operation were higher than that in group K, and the incidence rate of postoperative vomiting in group P was lower than that in group K(P < 0.05 to P < 0.01). ConclusionsFor children treated with tonsillectomy, compared with 0.5 mg/kg of low-dose ketamine the intravenous injection of 0.5 mg/kg of low-dose propofol after anesthesia can effectively reduce the cough, and incidence rates of nausea and vomiting, but the analgesic effect of propofol is not as good as ketamine. -
Key words:
- general anesthesia for children /
- cough /
- recovery of general anesthesia /
- propofol /
- ketamine
-
表 1 2组患儿一般资料比较(x±s)
分组 n 年龄/岁 男 女 体质量/kg 身高/cm 麻醉时间/min 麻醉结束至拔管时间/min 输液量/mL P组 45 6.64±2.54 29 16 23.96±9.99 110.42±15.74 41.08±2.99 5.7±3.02 304.11±115.02 K组 45 6.17±2.07 30 15 22.66±6.86 104.62±20.18 40.64±2.75 7.2±0.43 300.22±81.11 t — 0.96 0.05# 0.72 1.52* 0.73 3.30* 0.19 P — >0.05 >0.05 >0.05 >0.05 >0.05 < 0.05 >0.05 *示t′值;#示χ2值 表 2 2组患儿各时间段咳嗽率比较(n)
分组 n 咳嗽情况 T0~T1 T1~T2 T2~T3 T3~T4 T4~T5 T5~T6 P组 45 无 37 44 42 43 36 38 轻微 8 1 3 2 9 7 中度 0 0 0 0 0 0 重度 0 0 0 0 0 0 K组 45 无 7 10 15 18 20 18 轻微 24 19 20 21 15 19 中度 14 16 10 6 10 8 重度 0 0 0 0 0 0 uc — — 6.46 7.12 5.89 5.60 3.80 4.50 P — — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 表 3 2组患儿各时间点疼痛评分比较(x±s;分)
分组 n 10 min 20 min 30 min 60 min 2 h 4 h 8 h K组 45 1.88±0.44 2.22±0.59 2.73±0.98 2.33±0.52 1.08±1.44 0.08±0.44 0.00±0.00 P组 45 8.26±0.49 6.64±1.88 4.24±0.77 4.62±2.83 2.91±0.92 0.24±0.44 0.00±0.00 t — 64.99 15.05* 8.13 5.34* 7.18 1.72 — P — < 0.01 < 0.01 < 0.01 < 0.01 >0.05 >0.05 — *示t′值 -
[1] CONCEICAO MJ, BRUGGEMANN DA, CONCEICAO DC, et al. Effect of an intravenous single dose of ketamine on postoperative pain in tonsillectomy patients[J]. Paediatr Anaesth, 2006, 16(9): 962. doi: 10.1111/j.1460-9592.2006.01893.x [2] LEE B, LEE JR, NA S. Targeting smooth emergence: the effect site concentration of remifentanil for preventing cough during emergence during propofol-remifentanil anaesthesia for thyroid surgery[J]. Br J Anaesth, 2009, 102(6): 775. doi: 10.1093/bja/aep090 [3] AFSHAN G, CHOHAN U, QAMAR-UL-HODA M, et al. Is there a role of a small dose of propofol in the treatment of laryngeal spasm?[J]. Paediatr Anaesth, 2002, 12(7): 625. doi: 10.1046/j.1460-9592.2002.00937.x [4] HAMILTON ND, HEGARTY M, CALDER A, et al. Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit[J]. Pediatr Anaesth, 2012, 22(4): 345. doi: 10.1111/j.1460-9592.2011.03772.x [5] MINOGUE SC, RALPH J, LAMPA MJ. Laryngotrachealtopicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia[J]. Anesth Analg, 2004, 99(4): 1253. doi: 10.1213/01.ANE.0000132779.27085.52 [6] NEELAKANTA G, MILLER J. Minimum alveolar concentration of isoflurane for tracheal extubation in deeply anesthetized children[J]. Anesthesiology, 1994, 80(4): 811. doi: 10.1097/00000542-199404000-00013 [7] VENKATESAN T, KORULA G. A comparative study between the effects of 4% endotracheal tube cuff lignocaine and 1.5 mg/kg intravenous lignocaine on coughing and hemodynamics during extubation in neurosurgical patients: a randomized controlled double-blind trial[J]. J Neurosurg Anesthesiol, 2006, 18(4): 230. doi: 10.1097/00008506-200610000-00002 [8] GULER G, AKIN A, TOSUN Z, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation[J]. Acta Anaesthesiol Scand, 2005, 49(8): 1088. doi: 10.1111/j.1399-6576.2005.00780.x [9] RAJAN S, MALAYIL GJ, VARGHESE R, et al. Comparison of usefulness of ketamine and magnesium sulfate nebulizations for attenuating postoperative sore throat, hoarseness of. voice, and cough[J]. Anesth Essays Res, 2017, 11(2): 287. doi: 10.4103/0259-1162.181427 [10] YEH CC, WU CT, HUH BK, et al. Premedication with intravenous low-dose ketamine suppresses fentanyl-induced cough[J]. J ClinAnesth, 2007, 19(1): 53. [11] PAK HJ, LEE WH, JI SM, et al. Effect of a small dose of propofol or ketamine to prevent coughing and laryngospasm in children awakening from general anesthesia[J]. Korean J Anesthesiol, 2011, 60(1): 25. doi: 10.4097/kjae.2011.60.1.25 [12] BATRA YK, IVANOVA M, ALI SS, et al. The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children[J]. Paediatr Anaesth, 2005, 15(12): 1094. [13] OZTURK T, ACIKEL A, YILMAZ O, et al. Effects of low dose propofolvs ketamine on emergence cough in children undergoing flexible bronchoscopy with sevoflurane-remifentanil anesthesia: a randomized, double-blind, placebo-controlled trial[J]. J Clin Anesth, 2016, 35: 90. doi: 10.1016/j.jclinane.2016.06.025 [14] JUNG SY, PARK HB, KIM JD. The effect of a subhypnotic dose of propofol for the prevention of coughing in adults during emergence from anesthesia with sevoflurane and remifentanil[J]. Korean J Anesthesiol, 2014, 66(2): 120. doi: 10.4097/kjae.2014.66.2.120 [15] ORSER BA, BERTLIK M, WANG LY, et al. Inhibition by propofol(2, 6 di-isopropylphenol) of the N-methyl-D-aspartate subtype of glutamate receptor in cultured hippocampal neurones[J]. Br J Pharmacol, 1995, 116(2): 1761. doi: 10.1111/j.1476-5381.1995.tb16660.x