摘要
目的 比较不同局麻药佐剂用于患儿腹股沟疝修补术后镇痛的效果。方法 选取2020年6月至2021年8月在我院拟行腹股沟疝气修补术的患儿125例,按随机数字表法将患儿随机分为R组、RA组、RS组、RDX组及RDE组,每组25例。所有患儿缝合前行切口周围局部浸润麻醉。局麻液的配制:5组均为0.2%罗哌卡因5 ml,R组即原药液,RA组含肾上腺素25μg;RS组含舒芬太尼0.1μg/kg(≥30 kg为舒芬太尼3μg);RDX组含地塞米松0.2 mg/kg(≥25 kg为地塞米松5 mg);RDE组含右美托咪定0.3μg/kg。记录各组麻醉时间、手术时间、有效镇痛时间。采用FLACC疼痛行为评分法评估患儿在术后苏醒时(T_(0))、苏醒后1 h(T_(1))、2 h(T_(2))、3 h(T_(3))、4 h(T_(4))、5 h(T_(5))的疼痛程度。采用小儿苏醒期烦躁量表(PAED)评价患儿躁动程度。结果 RA、RDX、RDE组有效镇痛时间较R组、RS组延长,RDX组、RDE组有效镇痛时间较RA组延长,RDE组有效镇痛时间较RDX组延长(P<0.01)。5组患儿在T_(3)~T_(5)时FLACC评分差异有统计学意义(F值分别为3.929,11.087,4.075,P<0.01)。与R组比较,RA组在T_(3)时FLACC评分降低,RDX组在T_(3)、T_(4)时FLACC评分降低,RDE组在T_(3)~T_(5)时FLACC评分降低(P<0.01)。RS组和RDE组PAED评分及躁动发生率较R组下降(P<0.01)。结论 右美托咪定是较为理想的局麻药佐剂,与罗哌卡因配伍能有效延长镇痛时间,降低患儿麻醉苏醒期躁动的发生和程度。
Objective To compare the analgesic effects of different local anesthetic adjuvants after inguinal hernia repair in pediatric patients.Methods 125 pediatric patients with inguinal hernia repair from June 2020 to August 2021 in our Hospital were divided into Group R,RA,RS,RDX and RDE by using a random number table method(n=25 each).The local infiltration anesthesia was performed before suturing the incision.Preparation of local anesthetic solution:All 5 groups included 0.2% ropivacaine 5 ml,group R was set as the original solution,group RA contained adrenaline 25 μg,group RS contained sulfentanyl 0.1 μg/kg(Sulfentanyl 3 μg when body weight was greater than or equal to 30 kg),group RDX contained dexamethasone 0.2 mg/kg(dexamethasone 5 mg when body weight was greater than or equal to 25 kg) and group RDE contained dexmedetomidine 0.3 μg/kg.The anesthesia time,operation time and effective analgesia time was recorded.FLACC score was used to evaluate the pain degree of children at awakening(T_(0)),1 h after awakening(T_(1)),2 h(T_(2)),3 h(T_(3)),4 h(T_(4)) and 5 h(T_(5)).The restlessness degree of children was evaluated by PAED.Results The effective analgesic time in group RA,group RDX and group RDE was prolonged than that in group R and group RS,the analgesic time in group RDX and group RDE was prolonged than that in group RA,and the analgesic time in group RDE was prolonged than that in group RDX(P<0.01).There were significant differences in FLACC scores at T_(3)-T_(5) among the five groups(F value was 3.929,11.087 and 4.075 respectively,P<0.01).Compared with group R,the FLACC score of group RA was decreased at T_(3)(P<0.01),group RDX was decreased at T_(3) and T_(4),group RDE was decreased at T_(3)~T_(5)(P<0.01).The PAED scores and the incidences of agitation in group RS and group RDE were decreased compared with those in group R(P<0.01).Conclusion Dexmedetomidine is an ideal adjuvant for local anesthesia,and its combination with ropivacaine can effectively prolong the analgesic time and reduce the occurrence and
作者
陶勇
汪娜
叶勇
孙婷婷
胡悦
马国威
Tao Yong;Wang Na;Ye Yong(Department of Anesthesiology,The First People′s Hospital of Shuangliu District,West China(Airport)Hospital Sichuan University,Chengdu,Sichuan 610200,China.)
出处
《四川医学》
CAS
2022年第5期426-429,共4页
Sichuan Medical Journal
基金
成都市医学科研课题(编号:2020138)。
关键词
麻醉药
局部麻醉
佐剂
镇痛
疝
腹股沟
儿童
anesthetics
local anesthesia
adjuvant
analgesia
hernia
inguinal
child
