1、临床研究阿芬太尼用于埋伏多生牙患儿舒适化口腔治疗的效果李强谢丹丹叶玲玲缑海娣陈宇胡逸鹏肖煜胡华琨DOI:1012089/jca202301003基金项目:江西省卫生健康委科技计划(202311006)作者单位:330006南昌市，江西省儿童医院无痛诊疗中心(李强、缑海娣、陈宇、肖煜)，口腔科(谢丹丹、胡逸鹏);南昌大学第一附属医院麻醉与疼痛医学中心麻醉科(叶玲玲);江西省儿童医院麻醉科(胡华琨)通信作者:叶玲玲，Email:453043316 qqcom【摘要】目的观察和比较阿芬太尼和瑞芬太尼用于埋伏多生牙患儿舒适化口腔治疗的效果。方法选择拟在舒适化口腔治疗门诊行上颌前牙区埋伏多生牙拔除术的患
2、儿 153 例，男 94 例，女 59例，年龄 510 岁，体重 2241 kg，ASA或级，预计手术时间1 h。采用随机数字表法将患儿分为三组:阿芬太尼组(A 组)、瑞芬太尼组(组)和对照组(C 组)，每组 51 例。入室后吸入 8%七氟醚，待患儿意识消失后建立静脉通路，3 min 后停止吸入七氟醚，置入喉罩，行压力控制同步间歇指令通气。A 组持续吸入 2%4%七氟醚 2 L/min，同时静注阿芬太尼 10 g/kg，并以 1 gkg1min1持续静脉泵注至术毕，手术结束时逐步降低七氟醚吸入浓度直至关闭挥发罐;组静注瑞芬太尼 2.5g/kg，并以 0.25 gkg1min1静脉泵注至术毕，余
3、同 A 组;C 组给予等容量的生理盐水，余同 A组和 C 组。三组手术开始前，口腔科医师均采用 3%甲哌卡因通过计算机控制口腔麻醉系统实施切口局部浸润麻醉。记录麻醉诱导前(T0)、喉罩置入前即刻(T1)、牙龈切开时(T2)、去骨时(T3)、手术结束时(T4)的 H、SBP 和 DBP。记录术中七氟醚用量、术后喉罩拔除时间、苏醒时间、离院时间和术者满意度、输液量及阿托品和多巴胺的使用情况。记录苏醒期躁动、术后恶心呕吐、头晕、嗜睡、瘙痒等术后不良反应的发生情况。结果与 T0时比较，T2、T3时 C 组 H 明显增快，SBP 和 DBP 明显升高(P0.05);T1T4时 A 组和 组 H、SBP
4、和 DBP 差异无统计学意义。与 C 组比较，T2、T3时 A组和 组 H 明显减慢，SBP 和 DBP 明显降低(P0.05)，A 组和 组七氟醚用量和苏醒期躁动发生率明显降低(P0.05)。与 组比较，A 组和 C 组喉罩拔除时间明显缩短，A 组苏醒期躁动发生率明显降低(P0.05)。三组苏醒时间、离院时间、术者满意度、输液量、阿托品和多巴胺使用率以及术后恶心呕吐、头晕、嗜睡、瘙痒发生率差异无统计学意义。结论阿芬太尼可有效减轻埋伏多生牙患儿舒适化口腔治疗中的血流动力学波动，减少苏醒期躁动，减少七氟醚用量。【关键词】阿芬太尼;瑞芬太尼;埋伏多生牙;儿童;舒适化口腔治疗Effect of al
5、fentanil on oral comfort treatment in children with embedded supernumerary teethLIQiang，XIE Dandan，YE Lingling，GOU Haidi，CHEN Yu，HU Yipeng，XIAO Yu，HU Huakun PainlessDiagnosis and Treatment Center，Jiangxi Provincial Children s Hospital，Nanchang 330006，ChinaCorresponding author:YE Lingling，Email:45304
6、3316 qqcom【Abstract】ObjectiveTo observe and compare the effect of alfentanil and remifentanil on oralcomfort treatment in children with embedded supernumerary teeth MethodsA total of 153 children withembedded supernumerary teeth undergoing oral comfort treatment，94 males and 59 females，aged 510years
7、，weighing 2241 kg，ASA physical statusor，were randomly divided into three groups:alfentanilgroup(group A)，remifentanil group(group)and control group(group C)，51 children in each groupAfter entering the operating room，all children were inhaled with 8%sevoflurane After the children s con-sciousness dis
8、appeared，venous access was established After 3 minutes，the inhalation of sevoflurane wasstopped A laryngeal mask was placed，and implement pressure-controlled synchronous intermittent manda-tory ventilation was implement Group A was inhaled with 2%4%sevoflurane and 2 L/min fresh air flow，and given al
9、fentanil 10 g/kg intravenously，and intravenous pumping was performed at a rate of 1gkg1min1until the end of the operation At the end of the operation，the inhaled concentration ofsevoflurane was gradually reduced until the vaporizer tank was closed Group was given remifentanil 2.5g/kg intravenously，a
10、nd intravenous pumping was performed at a rate of 0.25 gkg1min1until theend of the operation，with the same other performance as in group A The same volume of normal saline was31临床麻醉学杂志 2023 年 1 月第 39 卷第 1 期J Clin Anesthesiol，January 2023，Vol39，No1given to group C，with the same other performance as i
11、n the previous two groups Before the operation of thethree groups，the stomatologists used 3%mepivacaine to perform local infiltration anesthesia through com-puter controlled oral anesthesia system H，SBP and DBP were recorded before induction of anesthesia(T0)，immediately before laryngeal mask placem
12、ent(T1)，at the time of gingival incision(T2)，at thetime of deboning(T3)，and at the end of surgery(T4)The dosage of sevoflurane was recorded Postopera-tive laryngeal mask extraction time，recovery time，discharge time，and surgeon satisfaction were recordedInfusion volume，the use rate of atropine and do
13、pamine The incidence of postoperative adverse reactionssuch as restlessness during recovery，postoperative nausea and vomiting，dizziness，drowsiness，and itchingwere recorded esultsCompared with T0，H，SBP and DBP were increased significantly in group C atT2and T3(P 0.05)Compared with T0，there was no sig
14、nificant difference in H，SBP and DBP ingroups A and at T1and T4 Compared with group C，H，SBP and DBP were decreased significantly ingroups A and at T2and T3(P 0.05)Compared with group C，the dosage of sevoflurane and the inci-dence of agitation were decreased significantly in groups A and (P 0.05)Comp
15、ared with group，thetime of laryngeal mask removal was decreased significantly in groups A and C，the incidence of agitationwere decreased significantly in group A(P 0.05)There was no significant difference in recovery time，discharge time，surgeon satisfaction，infusion volume，the use rate of atropine a
16、nd dopamine，and the inci-dence of postoperative nausea and vomiting，dizziness，somnolence，and pruritus among the three groupsConclusionAlfentanil can effectively reduce hemodynamic fluctuations，reduce emergence agitation，andreduce the amount of sevoflurane in oral comfort treatment for children with embedded supernumerary teeth【Keywords】Alfentanil;emifentanil;Embeddedsupernumeraryteeth;Child;Oralcomfort treatment埋伏多生牙多发于上颌前牙区，可影响恒牙正常萌出，造成牙齿畸形、牙列不齐，甚至导致牙根吸收、牙髓坏死以及含牙囊肿形成，严重威胁患儿口腔健康。在舒适化口腔治疗门诊进行手术拔除