摘要
目的探讨超声引导下右美托咪定复合罗哌卡因骶管阻滞对小儿尿道下裂修复术后镇痛和慢性疼痛的影响。方法选取行择期尿道下裂修复术患儿90例,随机分为罗哌卡因组(R组)和罗哌卡因+右美托咪定组(R+D组),每组45例。R组注射0.15%罗哌卡因1 mL/kg,R+D组注射0.15%罗哌卡因+右美托咪定1μg/kg。统计2组患儿麻醉时间、手术时间、住院时间、生命体征、小儿FLACC评分、Ramsay镇静(RSS)评分、不良反应发生率、膀胱痉挛发生率、有效镇痛时间和辅助用药剂量。记录2组患儿出院后1个月、2个月、3个月的FLACC评分。结果2组患儿手术时间、麻醉时间比较,差异无统计学意义(P>0.05);R+D组住院时间较R组短(P<0.05)。术后4 h、8 h、16 h,2组心率比较差异无统计学意义(P>0.05);术后24~72 h,R+D组心率较R组慢(P<0.05)。术后4 h,2组平均动脉压比较差异无统计学意义(P>0.05);术后8~72 h,R+D组平均动脉压较R组低(P<0.05)。术后4 h、8 h,2组FLACC评分比较差异无统计学意义(P>0.05);术后16 h、24 h、36 h、48 h、72 h,R+D组FLACC评分低于R组(P<0.05)。术后4 h、8 h、36 h、48 h、72 h,2组RSS评分比较差异均有统计学意义(P<0.05);术后16 h、24 h,2组RSS评分比较差异无统计学意义(P>0.05)。R+D组有效镇痛时间长于R组(P<0.05),布洛芬悬液和曲马多注射液用量均少于R组(P<0.05),2组恶心呕吐发生率比较差异无统计学意义(P>0.05),R+D组膀胱痉挛发生率低于R组(P<0.05)。出院后1个月,R+D组FLACC评分低于R组(P<0.05);出院后2个月、3个月,2组FLACC评分比较差异无统计学意义(P>0.05)。结论右美托咪定复合罗哌卡因骶管阻滞联合术后静脉镇痛,可延长有效镇痛时间,缩短住院时间,且镇痛期间不良反应少,术后3个月内患者均未见慢性疼痛的发生。
Objective To investigate the effect of ultrasound-guided dexmedetomidine combined with ropivacaine sacral block on postoperative analgesia and chronic pain in children with hypospadias repair.Methods A total of 90 children who underwent selective hypospadias repair were selected and randomly divided into the ropivacaine group(R group)and the ropivacaine+dexmedetomidine group(R+D group),with 45 cases in each group.The R group was injected with 0.15%ropivacaine 1 mL/kg,and the R+D group was injected with 0.15%ropivacaine+dexmedetomidine 1μg/kg.The anesthesia time,operation time,hospitalization time,vital signs,pediatric FLACC scores,Ramsay sedation scale(RSS)scores,incidence of adverse reactions,incidence of bladder spasm,effective analgesia time,and auxiliary medication dosage of the two groups were counted.The FLACC scores of the two groups 1 month,2 months,and 3 months after discharge were recorded.Results There was no statistically significant difference in operation time and anesthesia time between the two groups(P>0.05).The hospitalization time of the R+D group was shorter than that of the R group(P<0.05).There was no statistically significant difference in heart rate between the two groups 4 hours,8 hours and 16 hours after operation(P>0.05);the heart rate of the R+D group was slower than that of the R group 24 to 72 hours after operation(P<0.05).There was no statistically significant difference in mean arterial pressure between the two groups 4 hours after operation(P>0.05);The mean arterial pressure of the R+D group was lower than that of the R group 8 to 72 hours after operation(P<0.05).There was no statistically significant difference in FLACC scores between the two groups 4 hours and 8 hours after operation(P>0.05);the FLACC scores of the R+D group were lower than those of the R group 16 hours,24 hours,36 hours,48 hours and 72 hours after operation(P<0.05).There were statistically significant differences in RSS scores between the two groups 4 hours,8 hours,36 hours,48 hours and 72 hours after operation
作者
孙维国
周立平
王海彦
胡祖荣
杨世辉
SUN Wei-guo;ZHOU Li-ping;WANG Hai-yan;HU Zu-rong;YANG Shi-hui(Department of Anesthesiology,Guangdong Maternal and Child Health Hospital,Guangzhou Guangdong 511442,China;Department of Obstetrics,Guangdong Maternal and Child Health Hospital,Guangzhou Guangdong 511442,China)
出处
《局解手术学杂志》
2021年第6期511-515,共5页
Journal of Regional Anatomy and Operative Surgery
基金
广东省科技计划项目(2017ZC0321)。
