摘要
目的:考察静脉自控镇痛、切口局部浸润阻滞和腹横肌平面阻滞3种不同给药方式用于小儿腹腔镜阑尾切除术后镇痛的效果。方法:选取2018年4~11月我院收治的188例阑尾炎患儿作为研究对象,所有患儿均在静吸复合全麻下行腹腔镜阑尾炎切除术。术后根据患儿的住院号将患儿随机分为静脉自控镇痛组(PCIA组)、切口局部浸润阻滞组(LIB组)和腹横肌平面阻滞组(TAPB组)。PCIA组术后给予0.1μg/kg舒芬太尼作为负荷剂量,随后接自控镇痛泵镇痛,配方为:2μg/kg舒芬太尼+0.9%氯化钠注射液配制为100 ml溶液,背景输注2 ml/h,单次冲击量0.5 ml,锁定时间10 min;LIB组术后用0.25%罗哌卡因+0.1 mg/kg地塞米松混悬液0.5 ml/kg作切口周围局部浸润阻滞;TAPB组术后用0.25%罗哌卡因+0.1 mg/kg地塞米松混悬液0.5 ml/kg超声引导下作双侧腹横肌平面阻滞。记录患儿拔管后2、6、12、24、36、48 h FLACC评分和VAS评分,当FLACC评分≥4分,静脉注射吗啡0.05 mg/kg进行补救镇痛。记录术后48 h内补救镇痛率、吗啡使用频次与剂量、术后肠功能恢复时间、恶心呕吐、低血压、心动过缓、呼吸抑制、瘙痒、镇静过度、切口愈合等级和局部麻醉的相关并发症(穿刺部位血肿、感染、局部麻醉药中毒、穿破腹膜等)发生率。结果:与PCIA组和TAPB组比较,LIB组除了术后12 h VAS评分低于PCIA组外,其余各时间点FLACC评分和VAS评分均较高,补救镇痛率、吗啡使用频次与剂量较高,切口乙级愈合发生率较高(P<0.05);与PCIA组比较,TAPB组术后2、6、12、24 h FLACC评分和术后12、24 h VAS评分较高(P<0.05);与LIB组和TAPB组比较,PCIA组术后肠功能恢复时间延长以及术后恶心呕吐、呼吸抑制、镇静过度、瘙痒发生率较高(P<0.05)。结论:与静脉自控镇痛和切口局部浸润阻滞相比,罗哌卡因+地塞米松腹横肌平面阻滞用于小儿腹腔镜阑尾炎切除术后镇痛效果确切,不良反应�
Objective:To evaluate the postoperative analgesic efficacy of patient-controlled intravenous analgesia,local infiltration block and abdominal transverse plane block in pediatric patients undergoing laparoscopic appendectomy.Methods:A total of 188 patients scheduled for laparoscopic appendectomy in Nanyang Central Hospital,from April to November 2018 were included in the study.All children underwent laparoscopic appendectomy under combined venous and suction general anesthesia.Patients were divided into patient-controlled intravenous analgesia group(PCIA group),local infiltration block(LIB group)and transversus abdominis plane block group(TAPB group)according to the hospital case record numbers.In PCIA group,0.1μg/kg sufentanil was administered as a loading dose after surgery,followed by PCIA pump(sufentanil 2μg/kg dissolved in 100 ml saline)which was set up to deliver a 0.5 ml bolus dose with a 10 min lockout interval and background infusion at a rate of 2 ml/h.In LIB group,0.25%ropivacaine and 0.1 mg/kg dexamethasone(0.5 ml/kg)was used as a local infiltration block around the incision.In TAPB group,bilateral TAPB block was performed with 0.25%ropivacaine and 0.1 mg/kg dexamethasone mixture(0.5 ml/kg)under ultrasound guidance.Analgesia lasted until 48 h after operation in all groups.When FLACC(face,legs,activity,cry,consolability)scores≥4,morphine 0.05 mg/kg was injected intravenously as rescue analgesia.The FLACC and visual analog scale(VAS)scores were recorded at 2,6,12,24,36,48 hours after operation,the rate of rescue analgesia,dosage and frequency of morphine used,the recovery time of postoperative intestinal function and the incidence of adverse reactions,including nausea,vomiting,hypotension,bradycardia,respiratory depression,itching,over-sedation,healing rate of incision and adverse effects related to local sedation(hematoma at puncture site,infection,local anesthetic poisoning,peritoneum piercing)were also recorded within 48 h after operation.Results:Compared with PCIA and TAPB group,the rate of rescu
作者
王铭
司小萌
陈欢
WANG Ming;SI Xiao-meng;CHEN Huan(Department of Anesthesiology,Nanyang Central Hospital,Nanyang 473006,China)
出处
《中国合理用药探索》
CAS
2020年第8期45-49,共5页
Chinese Journal of Rational Drug Use
