颌面部鲜红斑痣患儿光动力治疗苏醒期躁动的影响因素及药物干预措施的观察性研究

doi:10.19438/j.cjoms.2024.03.010

摘要/Abstract

摘要： 目的：研究颌面部鲜红斑痣患儿光动力治疗苏醒期躁动（emergence agitation,EA）的风险因素,探讨围术期药物干预对EA的影响。方法：纳入2~12岁在全麻下行光动力治疗颌面部鲜红斑痣的患儿270例。收集患儿术前资料、患儿及家长术前焦虑评分,记录麻醉用药情况、苏醒期疼痛及躁动评分（PAED评分）。根据苏醒室PAED评分,将患儿分为EA组（PAED评分≥12）和非EA组（PAED评分<12）,比较组间各因素的差异,并进行校正回归分析,找出有效的药物干预措施。采用SPSS 25.0软件包对数据进行统计学分析。结果：EA组与非EA组在年龄、术前焦虑状态、诱导期阿片类药物、右美托咪定、拔管时间及术后疼痛评分方面均有显著差异（P<0.05）;矫正术前基线因素后,Logistics回归分析提示,诱导用阿片类药物芬太尼/舒芬太尼（OR=0.03,95%CI：0~0.16）、右美托咪定（OR=0.56,95%CI：0.33~0.95）是EA发生的保护因素。矫正基线后对苏醒期不同用量艾司氯胺酮回归分析,发现艾司氯胺酮0.5 mg/kg（OR=0.16,95%CI：0.04~0.50）和1 mg/kg（OR=0.07,95%CI：0.00~0.41）是EA的保护因素。结论：颌面部鲜红斑痣光动力治疗EA与年龄、患儿和家长的术前焦虑状态、拔管时间、术后疼痛相关,诱导使用舒芬太尼、苏醒期使用艾司氯胺酮（0.5~1 mg/kg）可有效降低EA的发生。

关键词: 儿童, 苏醒期躁动, 光动力治疗, 颌面部, 鲜红斑痣

Abstract: PURPOSE: To investigate the risk factors associated with postoperative emergence agitation(EA) in children with nevus flammeus in the maxillofacial region undergoing photodynamic therapy, and to identify optimal anesthetic interventions for efficacy. METHODS: A total of 270 children aged 2-12 years old who underwent photodynamic therapy under general anesthesia for the treatment of nevus flammeus were included. Preoperative anxiety scores of the patient and their parents, the use of anesthetics, and the degree of pain and Pediatric Anesthesia Emergence Delirium(PAED) scale during the recovery period were recorded. Based on PAED score in the recovery room, children were categorized into EA group(PAED score≥12) and non-EA group(PAED score<12). Differences between the groups were then compared. Logistic regression analysis, adjusted regression analysis were performed to identify effective anesthetics intervention measures with SPSS 25.0 software package. RESULTS: Significant differences were observed between EA group and non-EA group in terms of age, opioid anesthesia induction, dexmedetomidine administration, extubation time, preoperative anxiety of the children and their parents, and postoperative pain(P<0.05). After adjusting for preoperative baseline factors, logistic regression analysis showed that the induction opioid fentanyl/sufentanil(OR: 0.03, 95%CI: 0-0.16), dexmedetomidine（OR=0.56, 95%CI: 0.33-0.95）,esketamine 0.5 mg/kg(OR=0.16, 95%CI: 0.04-0.50), and 1 mg/kg(OR=0.07, 95%CI: 0.00-0.41) were the significant influencing factors for EA(P<0.05). CONCLUSIONS: Postoperative emergence agitation during photodynamic therapy for nevus flammeus is related to age, pain, anxiety, extubation time, dexmedetomidine. The use of sufentanil for induction and esketamine(0.5-1 mg/kg) during the recovery period can effectively reduce the occurrence of EA.

Key words: Postoperative emergence agitation, Pediatrics, Photodynamic therapy, Nevus flammeus, Maxillofacial region

中图分类号:

R782.05.4

周循, 索璐璐, 刘锦星, 周徐慧, 仇琳, 李静洁, 郑永超, 劳蔚. 颌面部鲜红斑痣患儿光动力治疗苏醒期躁动的影响因素及药物干预措施的观察性研究[J]. 中国口腔颌面外科杂志, 2024, 22(3): 261-267.

ZHOU Xun, SU Lu-lu, LIU Jin-xing, ZHOU Xu-hui, QIU Lin, LI Jing-jie, ZHENG Yong-chao, LAO Wei. Influencing factors and drug intervention measures for emergence agitation during photodynamic therapy in children with nevus flammeus in the maxillofacial region: an observational study[J]. China J Oral Maxillofac Surg, 2024, 22(3): 261-267.

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