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中华妇幼临床医学杂志(电子版) ›› 2024, Vol. 20 ›› Issue (06) : 707 -714. doi: 10.3877/cma.j.issn.1673-5250.2024.06.016

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儿童扁桃体切除术后镇痛管理研究现状
马凤婷1,2, 左云霞1,3, 邹剑4, 刘飞1,3,()   
  1. 1. 四川大学华西医院麻醉科,成都 610041
    2. 成都市双流区第一人民医院·四川大学华西空港医院麻醉科,成都 610200
    3. 四川大学华西医院·中国医学科学院“围术期应激风险评估与临床决策创新单元”(2018RU012),成都 610041
    4. 四川大学华西医院耳鼻咽喉头颈外科,成都 610041
  • 收稿日期:2024-06-21 修回日期:2024-11-13 出版日期:2024-12-01
  • 通信作者: 刘飞
  • 基金资助:
    四川省科技厅科技计划项目(2023ZYD0168)

Research status of analgesia management in children undergoing tonsillectomy

Fengting Ma1,2, Yunxia Zuo1,3, Jian Zou4, Fei Liu1,3,()   

  1. 1. Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China
    2. Department of Anesthesiology,The First People's Hospital of Shuangliu District,West China (Airport)Hospital,Sichuan University,Chengdu 610200,Sichuan Province,China
    3. The Research Units of West China(2018RU 012),Chinese Academy of Medical Sciences,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China
    4. Department of Otolaryngology,Head and Neck Surgery,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China
  • Received:2024-06-21 Revised:2024-11-13 Published:2024-12-01
  • Corresponding author: Fei Liu
引用本文:

马凤婷, 左云霞, 邹剑, 刘飞. 儿童扁桃体切除术后镇痛管理研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(06): 707-714.

Fengting Ma, Yunxia Zuo, Jian Zou, Fei Liu. Research status of analgesia management in children undergoing tonsillectomy[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(06): 707-714.

扁桃体切除术(tonsillectomy)是儿童最常见的外科手术之一,术后疼痛严重影响患儿康复。等离子刀和扁桃体部分切除术,在减轻患儿术后疼痛、减少术后并发症等方面,较其他手术方式更具优势,未来可能成为扁桃体切除术患儿首选手术方案。基于大量临床研究的系统评价证实,扁桃体切除术围术期规律口服布洛芬和对乙酰氨基酚,以及术中静脉注射地塞米松治疗扁桃体术后疼痛是安全有效的。儿童扁桃体切除术中阿片类药物应用,对术后即刻镇痛有效,但是由于其潜在的呼吸抑制风险,不推荐在儿童扁桃体切除术中常规使用。冷疗、蜂蜜和针灸作为多模式镇痛的非药物组成,可缓解儿童扁桃体切除术后患儿疼痛。术中使用右美托咪定和氯胺酮等药物,在减少扁桃体切除术患儿急性躁动、阿片类药物需求和辅助镇痛方面具有一定效果,但是研究数据迄今尚较少,并且研究质量偏低,尚需大样本、多中心随机临床试验进一步研究、证实。超声下引导舌咽神经阻滞(GNB)对扁桃体切除术后患儿疼痛有效,有望成为儿童扁桃体切除手术后镇痛的一种新策略。笔者拟就儿童扁桃体切除手术方式及术后疼痛发生机制,以及扁桃体切除术后患儿疼痛治疗策略的最新研究现状进行阐述,旨在为临床治疗该类患儿疼痛提供指导。

Tonsillectomy is one of the most common surgical procedures performed in children,and postoperative pain significantly impacts their recovery.Coblation and intracapsular tonsillotomy are emerging as superior techniques for tonsillectomy,offering advantages such as reducing postoperative pain,fewer complications,and faster recovery.A systematic review based on a large number of clinical studies has confirmed that regular oral administration of ibuprofen and acetaminophen,along with intraoperative dexamethasone,are safe and effective for the treatment of postoperative pain after tonsillectomy.The use of opioids during tonsillectomy in children is effective for immediate postoperative analgesia,but due to its potential risk of respiratory depression,its routine use in children is not recommended.Additionally,alternative therapies such as cold therapy,honey and acupuncture as non-drug components of multimodal analgesia can relieve pain in children after tonsillectomy.Dexmedetomidine and ketamine during tonsillectomy has a certain effect in reducing acute agitation,opioid requirements and auxiliary analgesia in children undergoing tonsillectomy.However,there are still few research data so far,and the research quality is low.Large-sample,multicenter randomized clinical trials are needed for further research and confirmation.Ultrasound-guided glossopharyngeal nerve block(GNB)is effective in treating pain in children after tonsillectomy and is expected to become a new strategy for postoperative analgesia in children after tonsillectomy.The author intends to explain the latest research status of the surgical methods of tonsillectomy and mechanisms of postoperative pain in children after tonsillectomy,as well as the treatment strategies for pain in children after tonsillectomy,aiming to provide guidance for the clinical treatment of pain in such children.

图1 扁桃体的神经支配示意图
图2 扁桃体切除术患儿术中镇痛的针灸穴位示意图(图2A:合谷穴;图2B:内关穴与神门穴;图2C:照海穴;图2D:扣带回穴、大脑主穴与扁桃体穴)
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