七氟醚与地氟醚麻醉对成人骨科患者苏醒期躁动影响的比较
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摘要
目的比较七氟醚与地氟醚对成人骨科手术患者苏醒期躁动(emergence agitation, EA)的影响。方法择期实施骨科手术的患者120例,男79例,女41例,年龄18～60岁,BMI 19.2～23.8 kg/m~2,ASAⅠ或Ⅱ级。患者依据随机原则分为七氟醚组(S组)和地氟醚组(D组),每组60例。在拔管前按照改良小儿苏醒期烦躁量表(PAED)评估EA程度,术后按照数字评价量表(nmeric rating scales, NRS)对患者术后疼痛程度进行评分,并观察分析舒芬太尼总量、手术时间、麻醉时间、苏醒时间、拔管时间和术后寒战、恶心呕吐等不良反应发生情况。记录两组患者强行体动、切口裂开、出血增多、自行拔除导管等严重不良反应发生情况。结果两组患者性别、年龄、身高、体重、BMI、ASA分级和手术种类等差异无统计学意义,两组患者舒芬太尼总量、手术时间、麻醉时间差异无统计学意义。D组患者改良PAED评分明显高于S组(P<0.05),苏醒时间明显短于S组(P<0.05),两组患者入恢复室15 min NRS评分、拔管时间、寒战、恶心呕吐等差异无统计学意义。两组患者均未出现强行体动、切口裂开、出血增多、自行拔除导管等严重不良反应。结论地氟醚麻醉的成人骨科患者术后尽管从全身麻醉中苏醒更快,但苏醒期躁动发生程度较七氟醚麻醉更为严重。在地氟醚麻醉中认识到苏醒期躁动的风险性并预防重大并发症是非常重要的。
Objective To compare of the effects of sevoflurane and desflurane on emergence agitation in adult patients undergoing orthopedics surgery. Methods One hundred and twenty adult patients scheduled to undergo orthopedics surgery, 79 males and 41 females, aged 18-60 years, BMI 19.2-23.8 kg/m~2, ASA physical status Ⅰ or Ⅱ, were randomized into two groups(n = 60): the sevoflurane group(group S) and the desflurane group(group D). Emergence agitation was evaluated with a modified pediatric anesthesia emergence delirium(PAED) scale before extubation. Postoperative pain was evaluated with a numerical rating scale(NRS). Total consumption of sufentanil, operative time, anesthesia time, recovery time, extubation time, chills, postoperative nausea and vomiting(PONV) were examined. Severe adverse reactions such as forced movement, incision dehiscence, increased bleeding and self-removal of catheter were recorded. Results There were no significant differences between the two groups regarding gender, age, height, body weight, BMI, ASA physical status, and operative types. Total consumption of sufentanil, operative time, and anesthesia time were also similar between the two groups. The improved PAED score of group D was significantly higher than that of group S(P < 0.05), but recovery time of group D was shorter than that of group S(P < 0.05). There was no significant difference between two groups in NRS score after 15 min in PACU, extubation time, chills and PONV. There were no serious adverse reactions such as forced movement, incision dehiscence, increased bleeding and self-removal of catheter in both groups. Conclusion The degree of emergence agitation after desflurane anesthesia in adult patients undergoing orthopedics surgery was more serious than of sevoflurane anesthesia,albeit they showed a faster recovery from general anesthesia. It is very important to recognize risk of emergence agitation and to prevent major complications during desflurane anesthesia.
Objective To compare of the effects of sevoflurane and desflurane on emergence agitation in adult patients undergoing orthopedics surgery. Methods One hundred and twenty adult patients scheduled to undergo orthopedics surgery, 79 males and 41 females, aged 18-60 years, BMI 19.2-23.8 kg/m~2, ASA physical status Ⅰ or Ⅱ, were randomized into two groups(n = 60): the sevoflurane group(group S) and the desflurane group(group D). Emergence agitation was evaluated with a modified pediatric anesthesia emergence delirium(PAED) scale before extubation. Postoperative pain was evaluated with a numerical rating scale(NRS). Total consumption of sufentanil, operative time, anesthesia time, recovery time, extubation time, chills, postoperative nausea and vomiting(PONV) were examined. Severe adverse reactions such as forced movement, incision dehiscence, increased bleeding and self-removal of catheter were recorded. Results There were no significant differences between the two groups regarding gender, age, height, body weight, BMI, ASA physical status, and operative types. Total consumption of sufentanil, operative time, and anesthesia time were also similar between the two groups. The improved PAED score of group D was significantly higher than that of group S(P < 0.05), but recovery time of group D was shorter than that of group S(P < 0.05). There was no significant difference between two groups in NRS score after 15 min in PACU, extubation time, chills and PONV. There were no serious adverse reactions such as forced movement, incision dehiscence, increased bleeding and self-removal of catheter in both groups. Conclusion The degree of emergence agitation after desflurane anesthesia in adult patients undergoing orthopedics surgery was more serious than of sevoflurane anesthesia,albeit they showed a faster recovery from general anesthesia. It is very important to recognize risk of emergence agitation and to prevent major complications during desflurane anesthesia.
引文
[1] 童珊珊,李军,彭春玲,等.麻醉恢复室的成年患者全麻苏醒期躁动危险因素分析.重庆医学,2015,44(10):1340-1342.
[2] 姜西刚,卞清明,辜晓岚.右美托咪定复合氟比洛芬酯预防全麻苏醒期躁动的临床研究.临床麻醉学杂志,2014,30(6):528-531.
[3] Ringblom J,W?hlin I,Proczkowska M.A psychometric evaluation of the pediatric anesthesia emergence delirium scale.Paediatr Anaesth,2018,28(4):332-337.
[4] 陈易,俞一瑾,倪新莉.术后恢复质量量表分析全麻苏醒期躁动的预警指标.临床麻醉学杂志,2013,29(8):782-784.
[5] 张宇华.全麻苏醒期躁动相关影响因素及预防措施分析.临床合理用药杂志,2017,10(34):137-138.
[6] Lim BG,Lee IO,Ahn H,et al.Comparison of the incidence of emergence agitation and emergence times between desflurane and sevoflurane anesthesia in children:a systematic review and meta-analysis.Medicine (Baltimore),2016,95(38):e4927.
[7] He J,Zhang Y,Xue R,et al.Effect of desflurane versus sevoflurane in pediatric anesthesia:a meta-analysis.J Pharm Pharm Sci,2015,18(2):199-206.
[8] Suzuki T,Kurazumi T,Ueda T,et al.Desflurane anesthesia worsens emergence agitation in adult patients undergoing thyroid surgery compared to sevoflurane anesthesia.JA Clin Rep,2017,3(1):36-41.
[9] Choi GJ,Baek CW,Kang H,et al.Emergence agitation after orthognathic surgery:a randomised controlled comparison between sevoflurane and desflurane.Acta Anaesthesiol Scand,2015,59(2):224-231.
[10] Veyckemans F.Excitation and delirium during sevoflurane anesthesia in pediatric patients.Minerva Anestesiol,2002,68(5):402-405.
[2] 姜西刚,卞清明,辜晓岚.右美托咪定复合氟比洛芬酯预防全麻苏醒期躁动的临床研究.临床麻醉学杂志,2014,30(6):528-531.
[3] Ringblom J,W?hlin I,Proczkowska M.A psychometric evaluation of the pediatric anesthesia emergence delirium scale.Paediatr Anaesth,2018,28(4):332-337.
[4] 陈易,俞一瑾,倪新莉.术后恢复质量量表分析全麻苏醒期躁动的预警指标.临床麻醉学杂志,2013,29(8):782-784.
[5] 张宇华.全麻苏醒期躁动相关影响因素及预防措施分析.临床合理用药杂志,2017,10(34):137-138.
[6] Lim BG,Lee IO,Ahn H,et al.Comparison of the incidence of emergence agitation and emergence times between desflurane and sevoflurane anesthesia in children:a systematic review and meta-analysis.Medicine (Baltimore),2016,95(38):e4927.
[7] He J,Zhang Y,Xue R,et al.Effect of desflurane versus sevoflurane in pediatric anesthesia:a meta-analysis.J Pharm Pharm Sci,2015,18(2):199-206.
[8] Suzuki T,Kurazumi T,Ueda T,et al.Desflurane anesthesia worsens emergence agitation in adult patients undergoing thyroid surgery compared to sevoflurane anesthesia.JA Clin Rep,2017,3(1):36-41.
[9] Choi GJ,Baek CW,Kang H,et al.Emergence agitation after orthognathic surgery:a randomised controlled comparison between sevoflurane and desflurane.Acta Anaesthesiol Scand,2015,59(2):224-231.
[10] Veyckemans F.Excitation and delirium during sevoflurane anesthesia in pediatric patients.Minerva Anestesiol,2002,68(5):402-405.