背景:急性阑尾炎(AA)是儿童急腹症的最常见原因。麻醉对小儿AA的手术治疗有显著影响,科学有效地选择麻醉药至关重要。
目的:评估阿托品(ATR)联合瑞芬太尼(REMI)在小儿AA手术中的临床效果。
方法:总共,选择在2020年5月至2023年5月期间治疗的108例小儿AA患者,其中58人接受ATR+REMI[研究组(RG)],50人接受REMI[对照组(CG)]。对睫毛反射消失的时间进行了比较分析,疼痛解决时间,麻醉恢复时间,不良事件发生率(AEs;呼吸抑制,低氧血症,心动过缓,恶心和呕吐,和低血压),术中反应(摇头,肢体活动,方位恢复,安全离开手术室的时间),血液动力学参数[氧饱和度(SPO2),平均动脉压,心率,和呼吸频率],术后镇静评分(Ramsay评分),和疼痛程度[面部,腿,活动,哭吧,可协性(FLACC)行为量表]。
结果:与CG相比,RG显示睫毛反射丧失的时间明显更短,疼痛解决,从麻醉中恢复,安全离开手术室.此外,总体AE的发生率(摇头,肢体活动,等。)较低,对术中血流动力学参数和应激反应指标的影响较少。拔管后30分钟的Ramsay评分和拔管后60分钟的FLACC评分在RG中明显低于CG。
结论:在接受AA手术的儿童中,ATR+REMI优于单独的REMI,AE的发生率较低,对血液动力学和应激反应的影响较少,和更好的麻醉后恢复。
BACKGROUND: Acute appendicitis (AA) is the most common cause of acute abdomen in children. Anesthesia significantly influences the surgical treatment of AA in children, making the scientific and effective selection of anesthetics crucial.
OBJECTIVE: To assess the clinical effect of atropine (ATR) in combination with
remifentanil (REMI) in children undergoing surgery for AA.
METHODS: In total, 108 cases of pediatric AA treated between May 2020 and May 2023 were selected, 58 of which received ATR + REMI [research group (RG)] and 50 who received REMI [control group (CG)]. Comparative analyses were conducted on the time to loss of eyelash reflex, pain resolution time, recovery time from anesthesia, incidence of adverse events (AEs; respiratory depression, hypoxemia, bradycardia, nausea and vomiting, and hypotension), intraoperative responses (head shaking, limb activity, orientation recovery, safe departure time from the operating room), hemodynamic parameters [oxygen saturation (SPO2), mean arterial pressure, heart rate, and respiratory rate], postoperative sedation score (Ramsay score), and pain level [the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale].
RESULTS: Compared with the CG, the RG showed significantly shorter time to loss of eyelash reflex, pain resolution, recovery from anesthesia, and safe departure from the operating room. Furthermore, the incidence rates of overall AEs (head shaking, limb activity, etc.) were lower, and influences on intraoperative hemodynamic parameters and stress response indexes were fewer. The Ramsay score at 30 min after extubation and the FLACC score at 60 min after extubation were significantly lower in the RG than in the CG.
CONCLUSIONS: ATR + REMI is superior to REMI alone in children undergoing AA surgery, with a lower incidence of AEs, fewer influences on hemodynamics and stress responses, and better post-anesthesia recovery.