吗啡、罗哌卡因混合液臂丛阻滞麻醉在儿童术后镇痛中的作用  

Effect of brachial plexus block with morphine and ropivacaine for postoperative analgesia in children

作　　者：沈国灿[1] 叶茂[1] 柏林[1] 徐颖[1] 李大珍[1] 

机构地区：[1]重庆医科大学儿童医院麻醉科,400014

出　　处：《中华创伤杂志》2010年第5期449-452,共4页Chinese Journal of Trauma

摘　　要：目的 观察儿童上肢手术后采用吗啡、罗哌卡因混合液臂丛阻滞镇痛的效果和不良反应. 方法选择45例择期行上肢手术的患儿,并随机数字表法均分为A组（罗哌卡因臂丛阻滞麻醉）、B组（罗哌卡因臂丛阻滞＋吗啡皮下注射麻醉）、C组（吗啡、罗哌卡因混合液臂丛阻滞麻醉）.以疼痛行为评估量表（FLACC）评价镇痛效果,以FLACC评分〈4分的维持时间作为有效镇痛时间.分别于术后1,2,4,6,8,12,24 h记录各组患儿镇痛情况、镇痛时间.并且随访术后48 h内不良反应的发生情况.结果 在镇痛时间与术后各时相点不需镇痛治疗的例数上,A组和B组间差异无统计学意义（P〉0.05）.与A、B组比较,C组镇痛时间显著延长,且术后4,6,8,12,24 h不需镇痛治疗的例数明显增多（P〈0.05）.三组不良反应均较轻微.结论 吗啡、罗哌卡因混合液臂丛阻滞用于儿童上肢手术后镇痛,能延长术后镇痛时间,效果确切,不良反应轻,安全可行.Objective To evaluate the efficacy and adverse effect of brachial plexus block with morphine and ropivacaine for postoperative analgesia in children. Methods Forty-five children undergone upper extremity surgery were randomly divided into three groups （n = 15） , ie, Croup A （brachial plexus block with ropivacaine）, Croup B （brachial plexus block with ropivacaine and subcutaneous injection of morphine） and Croup C （brachial plexus block with morphine and ropivacaine）. The analgesic effect and the analgesia maintenance time were recorded by FLACC method at 1, 2, 4, 6, 8, 12, 24 hours after operation. The adverse reactions were observed 48 hours after operation. Results There was no statistical difference between Croup A and Croup B in the analgesia maintenance time and the number of cases without analgesic therapy at each time point （P 〉 0. 05）. Compared with Croup A or Croup B, the analgesia maintenance time in Croup C were significantly extended and the number of cases without analgesic therapy at 4, 6, 8, 12, 24 hours after operation were significantly increased （P 〈 0.05）. The adverse effect was fairly light in three groups. Conclusion Brachial plexus block with morphine and ropivacaine may extend analgesia maintenance time effectively and safely in children undergone upper extremity surgery.

关 键 词：麻醉和镇痛 儿童 吗啡 罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]