小儿扁桃体腺样体切除术中外科脉搏氧指数和伤害性刺激指数对瑞芬太尼耗量与术后恢复的影响

doi:10.3969/j.issn.1006-5725.2025.13.011

摘要/Abstract

摘要：

目的通过比较小儿扁桃体腺样体手术中外科脉搏氧指数（surgical pleth index，SPI）和伤害性刺激指数（nociception index， NOX）两种不同伤害性刺激监测仪应用对瑞芬太尼耗量与术后恢复的影响，探寻适用于小儿伤害性刺激反应数量化监测的指标。方法选择我院接受气管插管全麻下行扁桃体腺样体手术的3 ~ 12岁患儿，根据SPI和NOX两种不同伤害性刺激监测仪的使用，随机分为常规组（R组，n = 19）、SPI组（S组，n = 19）和NOX组（N组，n = 18）。所有患儿常规禁食禁饮，以BIS监测仪监测镇静深度，SPI、NOX监测伤害性刺激反应，分别根据SPI、NOX监测值来调整瑞芬太尼的输注速率，监测指数维持在30 ~ 50。术毕带气管导管送PACU监护至苏醒。记录术中瑞芬太尼等麻醉药的消耗量；术后不同时间点疼痛评分、躁动评分及躁动发生率；记录麻醉、手术、拔除气管导管和恢复室停留时长；术后不良反应以及围术期生命体征。结果与R组比较，S组术中瑞芬太尼耗量和苏醒期躁动评分升高，差异有统计学意义（P < 0.05）。N组术中瑞芬太尼耗量和苏醒期躁动评分降低，3组患儿在PACU停留时间比较中S组停留时间最长，差异有统计学意义（P < 0.05）。3组其余指标如术后疼痛评分、躁动发生率和拔管时间等差异无统计学意义。结论小儿扁桃体腺样体手术中使用NOX指数作为伤害性刺激监测的数量化指标，能减少术中阿片类药物的总消耗量和术后恢复室停留时间。

关键词: 伤害性刺激监测, 小儿, 扁桃体腺样体切除术, 阿片类药物, 术后躁动

Abstract:

Objective To investigate the appropriate indicators for monitoring pediatric nociceptive stimulation， this study compared the SPI and NOX， two dual-parameter nociceptive stimulation monitors based on different principles， in terms of their effects on remifentanil consumption and postoperative recovery in pediatric adenotonsillectomy. Methods Children aged 3 ~ 12 years who were scheduled to undergo adenotonsillectomy under general anesthesia with endotracheal intubation were randomly assigned to the conventional group （Group R， n = 19）， the SPI group （Group S， n = 19）， and the NOX group （Group N， n = 18） according to the type of nociceptive stimulation monitor used. All children were subjected to routine fasting. The depth of anesthesia was monitored using a BIS monitor， and the remifentanil infusion rate was adjusted according to heart rate， SPI， or NOX values to maintain the index within the range of 30 ~ 50. After surgery， all children were transferred to the Post-Anesthesia Care Unit （PACU） with the tracheal catheter in place until they recovered. During the operation， the consumption of anesthetics such as remifentanil was recorded. Postoperatively， pain and agitation scores， the incidence of agitation at different time points， the duration of anesthesia， the surgical time， the time to extubation， and the length of stay in the recovery room were measured. Additionally， postoperative adverse reactions and perioperative vital signs were documented. Results In comparison with Group R， in Group N， the intraoperative consumption of remifentanil and the agitation score during the recovery period were significantly reduced. Conversely， in Group S， both of these two indicators were significantly elevated （P < 0.05）. Among the three groups， the residence time in the Post-Anesthesia Care Unit （PACU） was the shortest in Group N， and this difference was statistically significant （P < 0.05）. There were no significant disparities in the FLACC score， the incidence of agitation， and the extubation time among the three groups. Conclusions The NOX index can serve as a quantitative metric for monitoring nonciceptive stimulation during pediatric adenotonsillectomy. This index has the potential to decrease the intraoperative consumption of opioids and the residence time in the recovery room.

Key words: nociceptive stimulation monitoring, pediatric, adenotonsillectomy, opioid, emergency agitation

中图分类号:

R614.2+1

叶玉萍,李俊玲,刘国栋,韦勇,肖丹,黄赛君,徐世元. 小儿扁桃体腺样体切除术中外科脉搏氧指数和伤害性刺激指数对瑞芬太尼耗量与术后恢复的影响[J]. 实用医学杂志, 2025, 41(13): 2018-2024.

Yuping YE,Junling LI,Guodong LIU,Yong WEI,Dan XIAO,Saijun HUANG,Shiyuan XU. Effects of surgical pleth index and nociception index on the consumption of remifentanil and postoperative recovery in children undergoing adenotonsillectomy[J]. The Journal of Practical Medicine, 2025, 41(13): 2018-2024.

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项目	R组（n = 18)	S组（n = 19)	N组（n = 19)	χ²/F值	P值
性别/例				2.012	0.782
男	13	12	12
女	5	7	7
年龄/岁	7.77 ± 2.53	6.78 ± 3.01	7.05 ± 2.63	0.642	0.530
BMI/（kg/m²）	17.28 ± 2.09	16.72 ± 1.78	17.12 ± 2.17	0.372	0.691

项目	R组	S组	N组	F值	P值
MAP/mmHg
术前	85.17 ± 5.87	83.15 ± 8.19	79.42 ± 10.08	2.313	0.109
诱导后	77.78 ± 6.19	77.00 ± 7.21	73.84 ± 10.74	1.177	0.316
术毕	78.00 ± 5.84	79.47 ± 7.62	74.11 ± 9.79	2.307	0.109
HR/(次/min)
术前	94.39 ± 5.02	94.05 ± 7.59	97.16 ± 9.45	0.946	0.395
诱导后	92.61 ± 6.33	91.95 ± 5.79	91.68 ± 5.56	0.121	0.887
术毕	88.94 ± 3.69	91.79 ± 6.26	90.79 ± 6.41	1.251	0.243
SpO₂/%
术前	97.56 ± 2.45	98.15 ± 0.96	97.68 ± 2.56	0.421	0.659
诱导后	99.05 ± 0.62	99.16 ± 0.60	98.78 ± 2.57	1.048	0.358
术毕	99.17 ± 0.62	99.21 ± 0.42	99.16 ± 0.37	0.065	0.937
麻醉时长/min	44.05 ± 16.96	41.68 ± 15.12	42.31 ± 12.96	0.122	0.885
手术时长/min	23.66 ± 10.73	27.89 ± 15.18	25.21 ± 12.34	0,510	0.604

项目	R组	S组	N组	F值	P值
瑞芬太尼/μg	285.47 ± 132.97	350.92 ± 120.37^?	249.51 ± 106.64^?	3.471	0.038
纳布啡/mg	2.08 ± 2.57	2.02 ± 0.26	2.02 ± 0.60	1.104	1.166
丙泊酚/mg	0	8.18 ± 16.01	7.50 ± 14.88	0.104	1.166

项目	R组	S组	N组	F值	P值
FLACC
拔管后10 min	2.66 ± 0.48	2.63 ± 0.49	2.73 ± 0.56	0.205	0.815
拔管后20 min	2.55 ± 0.51	2.42 ± 0.69	2.68 ± 0.58	0.909	0.409
拔管后30 min	2.22 ± 0.64	2.63 ± 0.80	2.42 ± 0.76	0.371	0.692
拔管后2 h	2.00 ± 0.84	1.73 ± 0.80	1.78 ± 0.53	0.654	0.524
PAED
拔管后0 min	9.38 ± 2.59	9.73 ± 2.94	9.47 ± 2.61	0.083	0.920
拔管后10 min	7.94 ± 2.62	8.05 ± 2.09	7.05 ± 2.22	1.183	0.314
拔管后20 min	6.55 ± 1.94	6.36 ± 1.77	6.15 ± 1.67	0.227	0.798
拔管后30 min	4.36 ± 1.49	5.61 ± 1.94	4.21 ± 0.63	5.111	0.009
拔管后2 h	1.38 ± 1.14	1.63 ± 0.89	0.78 ± 0.71	4.118	0.022

项目	R组	S组	N组	F值	P值
拔管时间	19.23 ± 7.06	22.37 ± 6.14	20.63 ± 7.13	0.512	0.604
PACU停留时间	58.30 ± 13.93^*	73.81 ± 15.45	57.12 ± 11.50^*	4.740	0.017