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目的观察罗哌卡因局部浸润对全身麻醉下扁桃体摘除术后小儿躁动的影响。方法将择期行扁桃体摘除手术的患儿100例,年龄5~10岁,采用随机数字表法分为罗哌卡因组(R组)和对照组(C组),每组50例。R组手术开始时先给0.25%罗哌卡因5 ml于扁桃体周围浸润;C组手术开始时将等量生理盐水相同位置浸润。采用静吸复合全身麻醉。术中监测患者MAP、HR、Sp O2,并于术后15 min、30 min、1 h、4 h访视患者,根据小儿麻醉苏醒期躁动量化评分表(pediatric anesthesia emergence delirium scale,PAED)评估术后躁动的严重程度,记录镇痛药物使用剂量、不良反应如恶心、呕吐、瘙痒、呼吸抑制等发生例数。结果术后躁动、疼痛评分、特殊事件及处理2组评分比较,R组明显低于C组,差异有统计学意义(P<0.05);PAED各时间点评分峰值2组间差异有统计学意义[(10~15分)R组9例,C组17例,P<0.01;(15~20分)R组1例,C组5例,P≤0.01]。结论罗哌卡因局部浸润可以有效降低全身麻醉苏醒期躁动及并发症的发生率,值得在临床上推广。
Objective To observe the effect of local infiltration of ropivacaine on agitation of children after tonsillectomy under general anesthesia. Methods Totally 100 children undergoing tonsillectomy were randomly divided into ropivacaine group (R group) and control group (C group), 50 cases in each group. In the R group, 5 ml of 0.25% ropivacaine was infiltrated around the tonsil at the beginning of operation. At the beginning of operation, the same amount of saline was infiltrated in group C at the beginning of operation. Static inhalation combined with general anesthesia. The patients were monitored intraoperatively for MAP, HR and Sp O2. Patients were followed up at 15 min, 30 min, 1 h, and 4 h after operation. Pediatric anesthesia emergent delirium scale (PAED) Post-agitation severity, record the dose of analgesics, adverse reactions such as nausea, vomiting, itching, respiratory depression and other occurrences. Results Compared with group C, there were significant differences in scores of restlessness, pain score, special events and treatment in two groups (P <0.05). There was a significant difference between two groups [(10-15) R group 9 cases, C group 17 cases, P <0.01; (15-20 points) R group 1 cases, C group 5 cases, P≤0.01]. Conclusion Local infiltration of ropivacaine can effectively reduce the incidence of agitation and complications of general anesthesia during wakefulness and is worthy of clinical application.