任娜;赵宏娟;杨雪;刘曼嘉;赵晓春;

• 1:沈阳二四二医院麻醉科
• 2:中国医科大学附属盛京医院麻醉科

摘要(Abstract)：

目的评价酮咯酸氨丁三醇在小儿日间手术中的应用。方法选取2018年2月至2020年2月于沈阳二四二医院行扁桃体切除术患儿60例,年龄2～7岁,采用随机数字表法均分为酮咯酸氨丁三醇组(A组)和生理盐水对照组(B组),每组30例。患儿入室前20 min, A组给予酮咯酸氨丁三醇0.5 mg/kg, B组给予等量生理盐水对照。记录手术结束后1 h(T_1)、2 h(T_2)、4 h(T_3)的FLACC评分,拔管后10 min(T_4)、30 min(T_5)的PAED躁动评分和Ramsay镇静评分,并记录患儿出现皮肤红疹、恶心、呕吐不良反应的发生情况。结果 A组的FLACC评分和PAED躁动评分低于B组,差异有统计学意义(P<0.05)。两组Ramsay镇静评分和不良反应发生情况比较,差异无统计学意义(P>0.05)。结论酮咯酸氨丁三醇在小儿日间手术中能够减轻患儿术后疼痛,减少躁动的发生,无镇静作用,不增加术后不良反应发生率,可安全应用于小儿外科日间手术中。

关键词(KeyWords)： 酮咯酸氨丁三醇;镇痛;日间手术;儿童

Abstract:

Keywords:

基金项目(Foundation): 沈阳市中青年科技创新人才支持计划(RC190498)

作者(Author): 任娜;赵宏娟;杨雪;刘曼嘉;赵晓春;

Email:

DOI: 10.14053/j.cnki.ppcr.202108010

参考文献(References)：

• [1] Scherrer PD.Safe and sound:pediatric procedural sedation and analgesia[J].Minn Med,2011,94(3):43.
• [2] 王建光，连庆泉，张冰.小儿疼痛的评估[J].实用儿科临床杂志，2006,21(11):711-712.
• [3] Sikich N,Lerman J.Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale[J].Anesthesiology,2004,100(5):1138-1145.
• [4] 赵志钢，吴国远，梁艳华.酮咯酸氨丁三醇预防腹腔镜手术全麻苏醒期患者躁动的临床观察[J].中国老年保健医学，2011,9(3):28.
• [5] 彭云生.酮咯酸氨丁三醇超前镇痛对异腹烷吸入浓度的影响[J].医学伦理与实践，2012,25(3):549-550.
• [6] 蔡文琴.发育神经生物学[M].北京：科学出版社，2007:503-505.
• [7] 吴佳腾，崔晓光.小儿全身麻醉苏醒期躁动的研究进展[J].实用药物与临床，2017,20(3):357-360.
• [8] Teunkens A,Vermeulen K,Peters M,et al.Bupivacaine infiltration in children for postoperative analgesia after tonsillectomy:a randomised controlled study[J].Eur J Anaesthesiol,2019,36(3):206-214.
• [9] Zhu S,Qian W,Jiang C,et al.Ehanced recovery after surgery for hip and knee arthroplasty:a systematic review and meta-analysis[J].Postgrad Med,2017,93(1106):736-742.
• [10] Pogatzki-Zahn EM,Segelcke D,Schug SA.Postoperative pain-from mechanisms to treatment [J].Pain Rep,2017,2(2):e588.
• [11] Ge DJ,Qi B,Tang G,et al.Intraoperative dexmedetomidine promotes postoperative analgesia and recovery in patients after abdominal hysterectomy:a double-blind,randomized clinical trial[J].Sci Rep,2016,6:21514.
• [12] Flores-Murrieta FJ,Granados-Soto V.Pharmacologia properties of ketorolac tromethamine:a potent analgesic drug[J].CNS Drug Rev,2010,2(1):75-90.
• [13] Jadhav PA,Yadav AV.Design.development and characterization of ketorolac tromethamine polymetic nanosuspension[J].Ther Deliv,2019,10(9):585-597.
• [14] 朱鸣智，翟中云，林静吟，等.酮咯酸氨丁三醇联合腰丛神经阻滞对老年患者髋关节置换术快速康复的影响[J].广州医科大学学报，2017,45(6):59-62.
• [15] Vadivelu N,Kodumudi G,Roth B,et al.Safety considerations in the use of ketorolac for postoperative pain[J].Current Drug Safety,2017,12(1):67-73.
• [16] Viola E,Trifirò G,Ingrasciotta Y,et al.Adverse drug reactions associated with off-label use of ketorolac,with particular focus on elderly patients.An analysis of the Italian pharmacovigilance database and a population based study[J].Expert Opinion on Drug Safety,2016,15(suppl 2):61-67.
• [17] Gobble RM,Hoang HLT,Kachniarz B,et al.Ketorolac does not increase perioperative bleeding[J].Plastic Reconstructive Surg,2014,133(3):741-755.
• [18] Hungund S,Thakkar R.Effect of pretreatment with ketorolac tromethamine on operative pain during periodontal surgery:a case-control study[J].J Indian Soc Periodontol,2011,15(1):55-58.
• [19] Kim DH,Kim N,Lee JH,et al.Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities[J].J Pain Res,2018,11:2061-2070.
• [20] Dsida RM,Wheeler M,Birmingham PK,et al.Age-stratified pharmacokinetics of ketorolac tromethamine in pediatric surgical patients[J].Anesth Analg,2002,94(2):266-270.
• [21] Marzuillo P,Calligaris L,Amoroso S,et al.Narrative review shows that the short-term use of ketorolac is safe and effective in the management of moderate to severe pain in children[J].Acta Paediatr,2018,107(4):560-567.
• [22] Yu YD,Hwang JH,Seo YE,et al.Effects of nonsteroidal anti-inflammatory drugs as patient controlled analgesia on early bowel function recovery after radical cystectomy[J].Sci rep.2018;8(1):4658.
• [23] Mclay JS,Engelhardt T,Mohammed BS,et al.The pharmacokinetics of intravenous ketorolac in children aged 2months to 16years:a population analysis [J].Pediatr Anesthesia,2018,28(2):80-86.
• [24] Frederick HJ,Wofford K,Delisledear G,et al.A randomized controlled trial to determine the effect of depth of anesthesia on emergence agitation in children[J].Anesth Analg,2016,122(4):1141-1146.
• [25] Massó GEL,Patrignani P,Tacconelli S,et al.Variability among nonsteroidal anti-inflammatory drugs in risk of upper gastrointestinal bleeding [J].Arthritis Rheum,2010,62(6):1592-1601.
• [26] Wick EC,Grant MC,Wu CL.Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques:a review[J].JAMA Surg,2017,152(7):691-697.