罗哌卡因局部浸润超前镇痛在小儿扁桃体术后镇痛中的临床应用  

Clinical application of ropivacaine local infiltration preemptive analgesia in postoperative analgesia after pediatric tonsillectomy

作　　者：余庆波[1] 陈昌林[1] 李军祥[1] 

机构地区：[1]川北医学院附属医院麻醉科,四川南充637007

出　　处：《现代医药卫生》2013年第15期2264-2265,共2页Journal of Modern Medicine & Health

摘　　要：目的观察罗哌卡因局部浸润超前镇痛是否可以减少小儿扁桃体、腺样体切除后对镇痛药物的使用。方法将美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、择期行扁桃体切除术患儿80例随机分为罗哌卡因局部浸润组(R组)和对照组(C组),各40例。R组在全身麻醉后手术开始前采用0.25%罗哌卡因行双侧扁桃体窝和根部局部浸润,C组给予同等剂量生理盐水行双侧扁桃体窝和根部局部注射。比较两组患儿术后Wang-Baker笑脸量表评分,观察并记录两组患儿术后并发症及镇痛药物使用情况。结果 R组患儿术后30、60、120、180 min Wang-Baker笑脸量评分低于C组患儿(P<0.05),但术后240 min两组Wang-Baker笑脸量表评分分别为(1.9±0.5)、(2.1±0.6)分,两组比较,差异无统计学意义(P>0.05);两组患儿中需要追加镇痛药物患儿的百分率分别为2.5%(1/40)、27.5%(11/40),两组比较,差异有统计学意义(P<0.05)。R组患儿术后恶心呕吐[15.0%(6/40)、呼吸抑制[0.0%(0/40)]、嗜睡[0.0%(0/40)]发生率低于C组[20.0%(8/40)、7.5%(3/40)、7.5%(3/40)]患儿。结论罗哌卡因局部浸润超前镇痛可减少小儿扁桃体术后镇痛药物的使用和并发症的发生。Objective To observe whether preemptive ananlgesia with ropivacaine infiltration can reduce analgesics use after pediatric tonsillectomy and adenoidectomy.Methods 80 children patients with ASA Ⅰ-Ⅱ,scheduled for elective tonsillectomy were randomly allocated into the ropivacain infiltration group（R group） and the control group（C group）,40 cases in each group.The R group was conducted the local infiltration with 0.25% ropivacaine at the tonsil base as well as both sides of tonsillar fossa after the general anesthesia and before the operation begining,while the C group was injected with the same dose of normal saline at the same place.The postoperative Wang-Baker countenance scores were compared between the two groups.The postoperative complications and the use situation of analgesic drugs were also observed and recorded.Results The Wang-Baker countenance scores at postoperative 30,60,120,180 min in the R group were significantly lower than those in the C group（P0.05）,but which at postoperative 240 min had no statistical difference between the two groups（1.9±0.5 vs.2.1±0.6,P0.05）;the percent of the patients requiring additional analgesics in the two groups was 2.5%（1/40） and 27.5%（11/40） respectively,showing statistically significant difference（P0.05）.The occurrence rate of nausea and vomiting,respiratory depression and drowsiness in the R group were 15.0%（6/40）,0%（0/40） and 0%（0/40） respectively,which were lower than 20.0%（8/40）,7.5%（3/40） and 7.5%（3/40） in the C group.Conclusion Preemptive analgesia with ropavacaine local infiltration can reduce the analgesics use and the occurance of complications after pediatric tonsillectomy.

关 键 词：麻醉 局部 扁桃体切除术 疼痛 手术后 治疗 罗哌卡因 超前镇痛 

分 类 号：R766.9[医药卫生—耳鼻咽喉科]