摘要
目的观察不同浓度、相同容量的罗哌卡因在超声引导下经腹横平面腹壁神经(TAP)阻滞患儿腹腔镜术中、术后镇痛效果的差异。方法选择2012年9月至2013年3月四川大学华西医院儿童外科择期行腹腔镜下疝囊高位结扎术的120例患儿为研究对象,将其通过SPSS软件随机分为1组(n=30,采用0.062 5%罗哌卡因),2组(n=30,采用0.125%罗哌卡因),3组(n=30,采用0.25%罗哌卡因)和空白对照组(n=30,采用生理盐水)(本研究遵循的程序符合四川大学华西医院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试患儿监护人的知情同意,并与之签署临床研究知情同意书)。4组患儿年龄、体质量等一般情况比较,差异无统计学意义(P>0.05)。其均接受全身麻醉+超声引导下TAP阻滞。记录患儿术中生命体征变化、术后不同观察时刻FALCC评分、Ramsay评分、追加镇痛药物情况、不良反应及家长满意情况。结果①患儿术中生命体征变化方面,1,2,3组与空白对照组比较,差异有统计学意义(P<0.05),而1组分别与2,3组比较,差异也有统计学意义(P<0.05),2,3组间比较,差异无统计学意义(P>0.05)。②1,2,3组术后0.5h、1h、2h、4hFLACC评分与空白对照组比较,差异有统计学意义(P<0.05);而术后8h3组FLACC评分明显低于1,2组和空白对照组(P<0.05);4组间术后24h FLACC评分比较,差异无统计学意义(P>0.05)。③1,2,3组术后0.5h、1hRamsay评分与空白对照组比较,差异有统计学意义(P<0.05);2,3组术后2h、4hRamsay评分与1组和空白对照组比较,差异有统计学意义(P<0.05)。结论 1～3岁行腹腔镜下疝囊高位结扎术患儿应用超声引导下行TAP阻滞,选用罗哌卡因为局部麻醉药物,其术中、术后镇痛效果明确。相同容量下,高浓度局部麻醉药物较低浓度镇痛效果更完善、持续时间更长。适当降低罗哌卡因浓度而增加其药物容量,可能会获得更完善和安全的镇痛效果�
Objective To evaluate analgesic quality of ropivacaine with three different concentrations in children receiving transverses abdominis plane（TAP）block.Methods From September 2012 to March 2013,a total of 120 children undergoing laparoscopic high ligation of inguinal hernia combined general and TAP block were included in the study,and randomly divided into group 1（n=30,0.062 5% ropivacaine）, group 2（n=30,0.125% ropivacaine）,group 3 （n=30,0.25% ropivacaine）and control group （n=30, saline）.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Hosipital.Informed consent was obtained from each participates′parents.Intraoperative vital signs,postoperative FLACC scores and Ramsay scores were assessed up to 24 h after the operation.The need for additional analgesia agents,parents′s degree of satisfaction and the incidence of anesthesia-related complications were recorded.Results ① There had significant differences in vital signs between group 1 , 2,3 and control group respectively（P〈0.05）,and group 1 had obviously larger HR changes than that of group 2,3（P〈0.05）.No significant difference was found between group 2 and group 3 in HR changes （P〉0.05）.② There also had significant differences in FLACC scores at 0.5 h,1 h,2 h,4 h after operation between group 1,2,3 and control group respectively（P〈0.05）.Compared to other 3 groups,FLACC scores＆amp;nbsp;in group 3 at 8 h was obviously lower.③The Ramsay scores of control group within 1 h after operation were lower than other 3 groups .Conclusions Using the same capacity but high concentration of local anesthetic can provided the longer duration of analgesia,compared with the same capacity but low concentration of local anesthetic.Increased capacity of lower concentrations of ropivacaine will be provid similar efficacy,and may lead to a lower risk of local anaesthetic toxicity.
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2014年第2期82-86,共5页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
关键词
罗哌卡因
腹壁神经阻滞
儿童
Ropivacaine
Transverses abdominis plane
Child
