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目的:观察小儿唇腭裂手术麻醉苏醒期两种不同处理方法的临床效果,积累此类手术的临床经验。方法:择期小儿唇腭裂手术患者100例,随机分为:术后纳洛酮拮抗组(k组),不拮抗组(s组),每组50例。观察:两组术毕至完全清醒时间和术毕至气管拔管的时间,拔管后1min(T1),拔管后患儿15min(T2),拔管后30min(T3)的:平均动脉血压(MAP)、心率(HR)、脉搏血氧饱和度(SPO_2)以及术后并发症的发生率。结果:K组患儿完全清醒和气管拔管时间明显早于各对照组(P<0.05);拔管后3个时间点各组MAP和HR值的比较。两组间有明显的差异(P<0.05),K组较对照组MAP、HR值在T1、T2、T3三个时点增高(P<0.05),术后躁动发生率高于对照组(P<0.05)。结论:两组在小儿唇腭裂修复术的麻醉在术后苏醒期两种处理方法均安全可靠。K组术毕患儿清醒快,气管导管拔出早,患儿术后并发症的发生率较低;对照组术毕患儿血流动力学稳定,患儿苏醒质量较k组差。
OBJECTIVE: To observe the clinical effects of two different treatment methods during anesthesia and awake period in children with cleft lip and palate, and to accumulate the clinical experience of such surgery. Methods: 100 patients with elective cleft lip and palate surgery were randomly divided into naloxone antagonist group (k group) and non-antagonistic group (s group), 50 cases in each group. The duration of tracheal extubation and the time from operation to complete tracheal extubation, 1 minute after extubation (T1), 15 minutes after extubation (T2), 30 minutes after extubation (T3): mean arterial pressure (MAP), heart rate (HR), pulse oximetry (SPO_2) and the incidence of postoperative complications. Results: The time of complete awake and tracheal extubation in K group was significantly earlier than that of control group (P <0.05). The MAP and HR of each group were compared at 3 time points after extubation. There were significant differences between the two groups (P <0.05). MAP and HR in K group increased at T1, T2 and T3 (P <0.05), and the incidence of postoperative agitation was higher than that in control group (P <0.05). Conclusion: The two methods of anesthesia in children with cleft lip and palate repair during postoperative recovery are safe and reliable. The patients in group K were awake quickly and had early tracheal aspiration. The incidence of postoperative complications in children was lower than that in group k. The hemodynamics of children in control group were stable and the awakening quality was worse in children than in group k.