较深麻醉下拔管对脑瘫患儿行选择性脊神经后根切断术后躁动的影响

摘要 目的：探讨较深麻醉下拔管对脑瘫患儿行选择性脊神经后根切断术后躁动的影响。方法：2017年8月到2019年2月在本院进行诊治的脑瘫患儿89例，根据麻醉方法的不同把患儿分为观察组49例与对照组40例。所有患儿都给予选择性脊神经后根切断术治疗与全身麻醉。观察组在麻醉维持中静脉持续泵注丙泊酚进行较深麻醉下拔管，对照组吸入七氟烷进行较深麻醉下拔管，观察两组患儿术后躁动情况。结果：两组的麻醉时间、睁眼时间与拔管时间等对比差异无统计学意义(P>0.05)。观察组术后躁动发生率为2.0 %，显著低于对照组的15.0 % (P<0.05)。两组术后1个月的适应与语言行为评分都显著高于术前1 d (P<0.05)，且观察组也显著高于对照组 (P<0.05)。两组术后1个月的大脑中动脉收缩期峰值流速(Peak systolic flow velocity, Vs)、舒张末血流速度(End-diastolic blood flow velocity,Vd)都显著高于术前1 d (P<0.05)，且观察组也显著高于对照组(P<0.05)。结论：较深麻醉下拔管在脑瘫患儿行选择性脊神经后根切断术的应用能减少术后躁动的发生，且不影响麻醉效果，从而提高治疗效果，改善大脑血流动力学状况。

Effects of Extubation under Deep Anesthesia on Agitation after Selective Posterior Rhizotomy in Children with Cerebral Palsy

ABSTRACT Objective: To investigate the effects of extubation under deep anesthesia on agitation in children with cerebral palsy after selective posterior rhizotomy. Methods: From August 2017 to February 2019, 89 cases of children with cerebral palsy who were diagnosed and treated in our hospital were selected and were divided into observation group of 49 cases and control group of 40 cases accorded to different anesthesia methods. All children were treated with selective posterior rhizotomy and general anesthesia. The observation group were continuously pumped with propofol intravenously during deep anesthesia during anesthesia maintenance, and the control group were extubated under deep anesthesia with sevoflurane. Results: There were no significant difference in anesthesia time, eye opening time and extubation time compared between the two groups (P>0.05). The incidence of postoperative restlessness in the observation group were 2.0 %, which were significantly lower than 15.0 % in the control group (P<0.05). The postoperative 1 month of adaptation and speech behavior scores in the two groups were significantly higher than in the preoperative 1 d (P<0.05), and the observation group were significantly higher than the control group (P<0.05). The postoperative 1 month of Vs and Vd of the middle cerebral arteries in the two groups were significantly higher in the two groups than preoperative 1 d (P<0.05), and the observation group were significantly higher than the control group (P<0.05). Conclusion: The application of extubation under selective posterior rhizotomy in children with cerebral palsy undergoing selective spinal nerve root resection can reduce the occurrence of postoperative restlessness without affecting the effect of anesthesia, thereby improve the treatment effect and improving cerebral hemodynamics.