左旋布比卡因复合右美托咪定骶管阻滞用于小儿术后镇痛效果的观察  

Effect of dexmedetomidine in combination with levobupivacaine for caudal analgesia in pediatric surgery

作　　者：雷东旭 宋兴荣 潘永英 金宇林 岳丽 江雪玲 

机构地区：[1]广州市妇女儿童医疗中心麻醉科,广东广州510623

出　　处：《热带医学杂志》2014年第10期1324-1326,1335,共4页Journal of Tropical Medicine

摘　　要：目的探讨左旋布比卡因复合右美托咪定用于小儿骶管阻滞的有效镇痛时间及该方法的安全性。方法将拟行择期下腹部、会阴部或下肢手术的患儿80例随机分为左布组（L组）和左布＋右美组（L＋D组）,每组40例,年龄1-6岁。七氟烷诱导后,左布组骶管内注射0.25%左旋布比卡因1 ml/kg;左布＋右美组骶管内注射0.25%左旋布比卡因＋右美托咪定2μg/kg,总容量为1 ml/kg。观察记录患儿术后4、8、12、16、20、24 h的疼痛评分。记录两组患儿有效镇痛和苏醒时间。记录心动过缓、低氧血症、过度镇痛及恶心呕吐等不良反应的发生情况。结果 L组患儿术后4、8、12 h的疼痛评分高于L＋D组,差异有统计学意义（P〈0.05）。L＋D组患儿术后有效镇痛时间为20.1 h（18.5-21.7 h）,大于L组的7.7 h（5.8-9.6 h）,差异有统计学意义（P〈0.05）。两组患儿苏醒时间和术后恶心呕吐发生率差异均无统计学意义（P〉0.05）。未发生过度镇静、心动过缓和低氧血症等不良反应。结论右美托咪定可明显延长左旋布比卡因用于小儿骶管阻滞的有效镇痛时间,且术中、术后未见明显不良反应发生。Objective To examine the effective analgesia time and safety of adding dexmedetomidine to levobupivacaine for caudal anesthesia in pediatric surgery. Methods 80 patients（1 to 6 years） were randomly assigned into 2 groups. After anesthetic induction, each patient received a single caudal dose ： group L received caudal injection of 0.25% levobupivacaine（1 ml / kg）, group L＋D received 0.25% levobupivacaine（1 ml / kg） and dexmedetomidine 2 μg / kg. Standard monitoring and pain score evaluated by FLACC were performed every 4 hours. Effective analgesia time,recovery time and associated side effects such as over sedation, post-operative nausea and vomiting（PONV）, and bradycardia were observed and recorded for24 h after operation. Results The pain scores in group L at 4, 8, 12 hours after operation was significantly higher than those in group L＋D（P〈0.05）. The effective analgesia time of group L＋D was 20.1 h（18.5-21.7 h）, which was significantly longer than that in group L with the adequacy analgesia time of 7.7 h（5.8-9.6 h）（P〈0.05）. The recovery time and the incidence of PONV were comparable. No other side effects were obtained in the two groups. Conclusion Addition of dexmedetomidine to caudal levobupivacaine prolonged the duration of analgesia, without increase the incidence of side effects.

关 键 词：右美托咪定 骶管麻醉 术后镇痛 

分 类 号：R971.2[医药卫生—药品]