山东大学耳鼻喉眼学报 ›› 2023, Vol. 37 ›› Issue (1): 15-19.doi: 10.6040/j.issn.1673-3770.0.2021.538
• 论著 • 上一篇
冯琰琰1,张丹旭1,张康大1,王林雨1,王焕亮1,2,3
FENG Yanyan1, ZHANG Danxu1, ZHANG Kangda1, WANG Linyu1, WANG Huanliang1,2,3
摘要: 目的 评价耳大神经阻滞对七氟烷全麻人工耳蜗植入术患儿苏醒期谵妄(ED)的影响。 方法 择期七氟烷全麻下单侧人工耳蜗植入术患儿80例,0~6岁,ASA分级Ⅰ~Ⅱ级。采用随机数字表法分为耳大神经阻滞组(A组)和对照组(B组)。麻醉诱导后,A组在超声引导下耳大神经周围注入0.2%罗哌卡因1 mL,B组在切口周围注射2%利多卡因2 mL。七氟烷维持麻醉。术后使用儿童麻醉苏醒期谵妄量表(PAED)评估ED发生率,使用面部、腿部、活动、哭泣和安慰程度量表(FLACC)评估术后疼痛。PAED≥13分或FLACC≥4分者,给予芬太尼0.5 μg/kg静脉注射。记录患儿七氟烷平均用药浓度、ED持续时间、拔管时间、麻醉后恢复室(PACU)停留时间、芬太尼总用药量、护士满意度评分和术后24 h内不良反应发生率。 结果 与B组比较,A组ED发生率(P=0.036)和PAED(P=0.024)评分降低,FLACC评分(P=0.008)和FLACC≥4分的比率(P=0.006)降低,芬太尼补救镇痛率(P=0.011)降低,PACU停留时间(P=0.040)缩短,护士满意度(P=0.021)得到改善(P均<0.05),PAED≥13分的比率(P=0.289)、ED持续时间(P=0.962)、拔管时间(P=0.913)和术后不良反应发生率(P呕吐=0.737;P呛咳=0.487;P低氧=1.000)差异无统计学意义(P均>0.05)。 结论 耳大神经阻滞能降低七氟烷全麻人工耳蜗植入术后儿童苏醒期谵妄的发生率、减轻术后疼痛且不增加术后不良反应发生率。
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