瑞芬太尼、芬太尼对小儿扁桃体切除术中应激反应和苏醒期躁动的影响

目的：探讨瑞芬太尼、芬太尼对小儿扁桃体切除术中应激反应以及苏醒期躁动的影响。方法：选择2012年1月至2012年12月期间择期行扁桃体切除手术的患儿80例为研究对象，将其分随机为瑞芬太尼组（40例）和芬太尼组（40例），比较两组患者不同时间应激反应指标（ACTH、COR、IL-6）、苏醒时间、躁动评分、躁动发生率以及RamSay镇静评分，探讨两种麻醉药物的临床应用价值。结果：两组术前ACTH、COR、IL-6的基础应激指标比较，差别无统计学意义（P〉0．05）。瑞芬太尼组及芬太尼组术毕该三项指标较术前升高，术后1d较术毕有回落，差别有统计学意义（P〈0．05）；瑞芬太尼组术毕睐后1d的各项指标均远远低于芬太尼组，差别有统计学意义（P〈0．05）。瑞芬太尼组苏醒时间明显少于芬太尼组，躁动评分明显低于芬太尼组，躁动发生率明显低于芬太尼组，RamSay镇静评分明显高于芬太尼组，差别有统计学意义（P〈0．05）。结论：瑞芬太尼引起的应激反应明显弱于芬太尼组，且其苏醒期躁动情况明显优于芬太尼组，值得进一步推广应用。

The Influence of Remifentanil and Fentanyl on Stress Response and Restlessness in Pediatric Tonsillectomy

Objective： To investigate the influence of remifentanil and fentanyl on stress response and restlessness in pediatric tonsillectomy. Methods： 80 cases of children with tonsillectomy from January to December in 2012 were selected in the study, and all of them were randomly divided into two groups： the remifentanil group （ 40 cases ） and the fentanyl group （ 40 cases ）. The different time stress reaction Index （ACTH, COR, IL-6）, recovery time, agitation score, the incidence of agitation and RamSay sedation score were compared between two groups. Effects of the clinical value between two narcotic drugs were investigated. Results：The differences of preoperative based stress indicators of ACTH, COR, IL-6 between two groups were not statistically significant （P〉0.05）. The levels of three indicators increased in the two group after surgery, and decrease in ld after the surgery, the differences were statistically significant （P 〈0.05）. Each indicator after surgery and in ld after surgery in the remifentanil group were lower than those in the fentanyl group. The recovery time in the remifentanil group was significantly less than that in the fentanyl group. The incidence of agitation score and restlessness in the remifentanil group were significantly lower than those in the fentanyl group, RamSay sedation score in the remifentanil group was significantly higher than that in the fentanyl group, the differences were statistically significant （P〈0.05）. Conclusion：The stress response of remifentanil is significantly weaker than fentanyl, its restlessness is better than fentanyl, thus it is worthy of further promotion.