盐酸达克罗宁胶浆在患儿扁桃体切除术中的应用
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摘要
目的观察盐酸达克罗宁胶浆对患儿扁桃体切除术围术期血流动力学、术后疼痛及苏醒期躁动的影响。方法选择2017年1月至2018年2月全麻下择期行双侧扁桃体切除术患儿60例,男39例,女21例,年龄3～10岁,BMI 10～34 kg/m~2,ASAⅠ或Ⅱ级。随机分为3组:单次用药组(SD组)、重复用药组(RD组)和对照组(CG组),每组20例。SD组麻醉前15 min含服5 ml盐酸达克罗宁胶浆5 min;RD组麻醉前15 min含服5 ml盐酸达克罗宁胶浆5 min,术毕前扁桃体窝内均匀涂抹盐酸达克罗宁胶浆2 ml;CG组麻醉前15 min含服5 ml空白胶浆5 min,术毕前扁桃体窝内涂抹空白胶浆2 ml,所有患儿均采用气管插管全麻。记录麻醉诱导前(T_0)、插管即刻(T_1)、扁桃体剥离时(T_2)、入PACU 30 min(T_4)、入PACU 60 min(T_5)时HR、MAP;记录麻醉时间、手术时间、苏醒时间、拔管时间,记录患儿入PACU时(T_3)、入PACU 30 min(T_4)、入PACU 60 min(T_5)时FLACC和PAED评分;记录术后恶心呕吐、创面渗血、呼吸道梗阻、低氧血症等不良反应发生情况。结果与T_0时比较,T_1、T_2时SD组和RD组HR明显减慢、MAP明显降低(P<0.05),T_4、T_5时SD组HR明显增快、RD组MAP明显降低(P<0.05),T_1、T_4和T_5时CG组HR明显增快(P<0.05)。T_1、T_2时SD组和RD组HR明显慢于CG组,且MAP明显低于CG组(P<0.05);T_4、T_5时RD组HR明显慢于SD组和CG组,且MAP明显低于SD组和CG组(P<0.05)。T_3、T_4和T_5时,RD组的FLACC、PAED评分明显低于SD和CG组(P<0.05)。三组患儿术后恶心呕吐、创面渗血、呼吸道梗阻、低氧血症等不良反应差异无统计学意义。结论患儿扁桃体切除术麻醉前和术毕应用盐酸达克罗宁胶浆,不仅明显减少围术期血流动力学波动,还可有效缓解患儿术后疼痛,减少苏醒期躁动。
Objective To observe the effect of perioperative hemodynamics, postoperative pain and waking restlessness of dyclonine hydrochloride during tonsillectomy of children. Methods Sixty children from January 2017 to February 2018 undergoing elective tonsillectomy were selected,including 39 males and 21 females, aged 3-10 years, BMI 10-34 kg/m~2,ASA physical statusⅠ or Ⅱ. They were divided into three groups randomly: single dose group(group SD), repeated dose group(group RD) and control group(group CG), with 20 cases in each group. In group SD, 15 min before anesthesia, 5 ml of dyclonine hydrochloride mucilage was sucked for 5 min. In group RD, 15 min before anesthesia, 5 ml of dyclonine hydrochloride mucilage was sucked for 5 min and 2 ml of dyclonine hydrochloride mucilage was smeared around each tonsillectomy fossa at the end of operation. 5 ml of blank mucilage was sucked 15 min before anesthesia and 2 ml of blank mucilage was smeared around each tonsillectomy fossa at the end of operation in group CG. General anesthesia with endotracheal intubation were applied on all the children. HR and MAP were recorded before anesthesia induction(T_0), immediately after intubation(T_1), at the time of tonsillar dissection(T_2), 30 min after PACU(T_4), and 60 min after PACU(T_5), respectively. Anesthesia time, operation time, waking time and extubating time were recorded. FLACC and PAED scores were recorded when the children were in PACU(T_3), 30 min after PACU(T_4), and 60 min after PACU(T_5), respectively. The incidence of adverse reactions such as postoperative nausea and vomiting, wound bleeding, respiratory obstruction, hypoxemia were recorded. Results Compared with T_0, HR and MAP in group SD and group RD decreased significantly at T_1 and T_2(P < 0.05). At T_4 and T_5, HR in group SD increased significantly, and MAP in group RD decreased significantly(P < 0.05). The HR in the group SD and group RD was significantly slower than that in the group CG at T_1 and T_2, and the MAP was significantly lower than that in group CG(P < 0.05). The HR in group RD was significantly slower than that in group SD and group CG at T_4 and T_5, and the MAP was significantly lower than that in group SD and group CG(P < 0.05). At T_3, T_4 and T_5, the FLACC and PAED scores of group RD were significantly lower than those of group SD and group CG(P< 0.05). There were no statistically significant difference in postoperative nausea and vomiting, wound bleeding, respiratory obstruction, hypoxemia and other adverse reactions after anesthesia among the three groups. Conclusion The application of dyclonine hydrochloride mucilage before anesthesia and following tonsillectomy in children can not only reduce the hemodynamic fluctuation in the perioperative period significantly, but also effectively relieve the postoperative pain of children and reduce the restlessness in the waking period.
Objective To observe the effect of perioperative hemodynamics, postoperative pain and waking restlessness of dyclonine hydrochloride during tonsillectomy of children. Methods Sixty children from January 2017 to February 2018 undergoing elective tonsillectomy were selected,including 39 males and 21 females, aged 3-10 years, BMI 10-34 kg/m~2,ASA physical statusⅠ or Ⅱ. They were divided into three groups randomly: single dose group(group SD), repeated dose group(group RD) and control group(group CG), with 20 cases in each group. In group SD, 15 min before anesthesia, 5 ml of dyclonine hydrochloride mucilage was sucked for 5 min. In group RD, 15 min before anesthesia, 5 ml of dyclonine hydrochloride mucilage was sucked for 5 min and 2 ml of dyclonine hydrochloride mucilage was smeared around each tonsillectomy fossa at the end of operation. 5 ml of blank mucilage was sucked 15 min before anesthesia and 2 ml of blank mucilage was smeared around each tonsillectomy fossa at the end of operation in group CG. General anesthesia with endotracheal intubation were applied on all the children. HR and MAP were recorded before anesthesia induction(T_0), immediately after intubation(T_1), at the time of tonsillar dissection(T_2), 30 min after PACU(T_4), and 60 min after PACU(T_5), respectively. Anesthesia time, operation time, waking time and extubating time were recorded. FLACC and PAED scores were recorded when the children were in PACU(T_3), 30 min after PACU(T_4), and 60 min after PACU(T_5), respectively. The incidence of adverse reactions such as postoperative nausea and vomiting, wound bleeding, respiratory obstruction, hypoxemia were recorded. Results Compared with T_0, HR and MAP in group SD and group RD decreased significantly at T_1 and T_2(P < 0.05). At T_4 and T_5, HR in group SD increased significantly, and MAP in group RD decreased significantly(P < 0.05). The HR in the group SD and group RD was significantly slower than that in the group CG at T_1 and T_2, and the MAP was significantly lower than that in group CG(P < 0.05). The HR in group RD was significantly slower than that in group SD and group CG at T_4 and T_5, and the MAP was significantly lower than that in group SD and group CG(P < 0.05). At T_3, T_4 and T_5, the FLACC and PAED scores of group RD were significantly lower than those of group SD and group CG(P< 0.05). There were no statistically significant difference in postoperative nausea and vomiting, wound bleeding, respiratory obstruction, hypoxemia and other adverse reactions after anesthesia among the three groups. Conclusion The application of dyclonine hydrochloride mucilage before anesthesia and following tonsillectomy in children can not only reduce the hemodynamic fluctuation in the perioperative period significantly, but also effectively relieve the postoperative pain of children and reduce the restlessness in the waking period.
引文
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[7] 王俊林,黄群,费建,等.布比卡因局部喷雾用于患儿扁桃体切除术后镇痛的临床研究.临床麻醉学杂志,2014,30(2):29-31.
[8] 中国医师协会麻醉学医师分会.促进术后康复的麻醉管理专家共识.中华麻醉学杂志,2015,35(2):141-148.
[9] 左云霞,冯春,刘飞,等.小儿术后镇痛专家共识.//熊利泽,邓小明.中国麻醉学指南与专家共识.北京:人民卫生出版社,2017:295-311.
[10] 李强,胡华琨,沈世晖,等.盐酸达克罗宁胶浆含服复合利多卡因咽喉部喷雾在患儿食管扩张术中的麻醉效果.临床麻醉学杂志,2018,34(5):459-462.
[11] Jichao S,Cuida M,Mingxing C,et al.Oral dyclonine hydrochloride mucilage versus tetracaine spray in electronic flexible laryngoscopy:a prospective,randomized controlled trial.Am J Otolaryngol,2016,37(2):169-171.
[12] 程勇卫,林燕鸿,周少明.盐酸达克罗宁胶浆在儿童胃镜检查中的临床观察.中国当代医药,2016,23(20):105-107.
[13] 张忠勤,叶凤卿,吴耀滨,等.口服达克罗宁胶浆对扁桃体剥离手术中血流动力学的影响.广东医学,2016,37(1):43-44.
[2] Sikich N,Lerman J.Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale.Anesthesiology,2004,100(5):1138-1145.
[3] Vons KM,Bijker JB,Verwijs EW,et al.Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children.Paediatr Anaesth,2014,24(5):476-482.
[4] Stanko D,Bergesio R,Davies K,et al.Postoperative pain,nausea and vomiting following adeno-tonsillectomy—a long-term follow-up.Paediatr Anaesth,2013,23(8):690-696.
[5] Dorkham MC,Chalkiadis GA,von Ungern Sternberg BS,et al.Effective postoperative pain management in children after ambulatory surgery,with a focus on tonsillectomy:barriers and possible solutions.Paediatr Anaesth,2014,24(3):239-248.
[6] Kelly LE,Rieder M,van den Anker J,et al.More codeine fatalities after tonsillectomy in North American children.Pediatrics,2012,129(5):e1343-e1347.
[7] 王俊林,黄群,费建,等.布比卡因局部喷雾用于患儿扁桃体切除术后镇痛的临床研究.临床麻醉学杂志,2014,30(2):29-31.
[8] 中国医师协会麻醉学医师分会.促进术后康复的麻醉管理专家共识.中华麻醉学杂志,2015,35(2):141-148.
[9] 左云霞,冯春,刘飞,等.小儿术后镇痛专家共识.//熊利泽,邓小明.中国麻醉学指南与专家共识.北京:人民卫生出版社,2017:295-311.
[10] 李强,胡华琨,沈世晖,等.盐酸达克罗宁胶浆含服复合利多卡因咽喉部喷雾在患儿食管扩张术中的麻醉效果.临床麻醉学杂志,2018,34(5):459-462.
[11] Jichao S,Cuida M,Mingxing C,et al.Oral dyclonine hydrochloride mucilage versus tetracaine spray in electronic flexible laryngoscopy:a prospective,randomized controlled trial.Am J Otolaryngol,2016,37(2):169-171.
[12] 程勇卫,林燕鸿,周少明.盐酸达克罗宁胶浆在儿童胃镜检查中的临床观察.中国当代医药,2016,23(20):105-107.
[13] 张忠勤,叶凤卿,吴耀滨,等.口服达克罗宁胶浆对扁桃体剥离手术中血流动力学的影响.广东医学,2016,37(1):43-44.