骶管右美托咪定对儿童先天性巨结肠Soave手术急性内脏痛的镇痛作用  

Analgesia against acute visceral pain of caudal injection of dexmedetomidine in the children with Hirschsprung＇s disease undergoing Soave operation

作　　者：刘亚涛[1] 冷玉芳[1] 刘永强[1] 万占海[1] 鲁雅琴[2] 

机构地区：[1]兰州大学第一医院麻醉科,甘肃兰州730000 [2]兰州大学第一医院神经内科,甘肃兰州730000

出　　处：《中国急救医学》2013年第5期443-447,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨增加右美托咪定到骶管罗哌卡因对儿童先天性巨结肠Soave手术急性内脏痛的镇痛作用，并观察镇静作用。方法24例择期Soave手术患儿随机平分为两组，气管插管后异氟醚吸人维持并行骶管阻滞。右美托咪定（D组）：右美托咪定1μg／kg＋0．25％罗哌卡因混合液1mlMkg，对照组（C组）：0．25％罗哌卡因1mL／kg。手术中观察患儿血流动力学变化，监测脑电双频指数（bispectralindex，BIS）、呼末异氟醚浓度（end - tidal concentration of isoflurane,ETiso）。记录手术后苏醒时间。手术后不同时点采用小儿的疼痛行为评估（FLACC）疼痛评分和睁眼反应评分对患儿进行镇痛、镇静评分并比较。结果手术中平均ETisoD组低于C组（P〈0．01）。Kaplan—Meier生存分析比较两组手术后24h内首次镇痛药物治疗时间，D组10（8—12）h长于C组4（3～5）h（P〈0．01）。手术后D组2、4、8hFLACC疼痛评分低于C组（P〈0．05），镇静时间长于C组（P〈0．01）。手术中血流动力学变化、手术后苏醒时间等比较差异无统计学意义。结论在儿童先天性巨结肠Soave手术中，增加右美托咪定到骶管罗哌卡因，产生显著抑制急性内脏疼痛及镇静的协同作用，且未观察到不良反应。Objective To determine whether the addition of dexmedetomidine to caudal injection with ropivacaine promote the analgesia against acute visceral pain in children with Hirschsprung disease undergoing Soave operation and to observe the sedation. Methods Twenty - four children scheduled for Soave operation were evenly and randomly assigned into two groups. After tracheal intubation, group C received caudal injection of ropivacaine 0.25%, 1 mL/kg; group D received the same dose of ropivacaine mixed with dexmedetomidine 1 μg/kg during isoflurane anesthesia. Haemodynamic variables, bispectral index （BIS） and end - tidal concentration of isoflurane （ETiso） were monitored during operation. Emergence time was recorded. The FLACC pain scale and the score based on eye opening were used respectively to assess the analgesia and sedation at postoperative different time - points. The incidence of emergence agitation and respiratory depression were also recorded. Results The average ETiso was lower in group D than that in group C （P 〈 0.01 ）. Kaplan - Meier survival analysis and log - rank test showed that the time of first analgesia administration during twenty - four hours postoperatively was 10 （ 8 - 12） h [ median （95% confidence interval, CI） ] in group D, which was longer than 4 （3 -5） h in group C （P 〈0.01）. The FLACC pain scores were lower in group D than in group C at 2, 4, 8 h postoperatively （P 〈 0.05 ）. Children in group D were sedated for longer time compared with group C （ P 〈 0.01 ）. No statistical differences were found in haemodynamic changes perioperatively, emergence time and incidence of side - effects. Conclusion The caudal injection of dexmedetomidine 1 p.g/kg in combination with ropivacaine produce significant synergistic action on the analgesia against acute visceral pain and sedation without increasing the incidence of adverse effects in children with Hirschsprung~ disease undergoing Soave operation.

关 键 词：右美托咪定 骶管阻滞 内脏痛 急性 镇痛 

分 类 号：R656.9[医药卫生—外科学]