右美托咪定混合罗哌卡因骶管阻滞用于小儿围术期镇痛管理的评价  

Evaluation of caudal block with dexmedetomidine mixed with ropivacaine for management of perioperative analgesia in children

作　　者：李新宇[1] 张莉[1] 崔云凤[1] 潘振祥[1] 

机构地区：[1]吉林大学第二医院麻醉科,长春市130041

出　　处：《中华麻醉学杂志》2015年第2期194-196,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价右美托咪定混合罗哌卡因骶管阻滞用于小儿围术期镇痛管理的效果.方法 择期拟行尿道下裂手术患儿60例,年龄1～5岁,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其分为2组（n=30）：罗哌卡因组（R组）和右美托咪定混合罗哌卡因组（DR组）.R组骶管注射0.25％罗哌卡因1 ml/kg;DR组骶管注射0.25％罗哌卡因1 ml/kg与右美托咪定2μg/kg混合液.于术后24 h内采用FLACC评分法评价镇痛效果,采用改良Bromage评分法评价运动阻滞程度,记录镇痛时间（骶管阻滞起效至术后首次使用补救镇痛药物的时间）及不良反应发生情况.结果 与R组比较,DR组镇痛时间明显延长,心动过缓及过度镇静发生率明显升高（P＜0.05）,而两组均未见低氧血症、低血压、术后运动阻滞发生.结论 骶管注射右美托咪定2 μg/kg可显著优化单纯罗哌卡因骶管阻滞用于小儿围术期镇痛管理的效果.Objective To evaluate the efficacy of caudal block with dexmedetomidine mixed with ropivacaine for the management of perioperative analgesia in children.Methods Sixty pediatric patients,aged 1-5 yr,of ASA physical status Ⅰ or Ⅱ,scheduled for elective hypospadias repair,were equally and randomly assigned into 2 groups using a random number table：ropivacaine group （group R） and dexmedetomidine mixed with ropivacaine group （group DR）.Each patient received a single caudal dose of 0.25% ropivacaine 1 ml/kg in group R.Each patient received a single caudal dose of 0.25% ropivacaine 1 ml/kg mixed with dexmedetomidine 2 μg/kg in group DR.Postoperative analgesia was assessed using FLACC scale,and the degree of motor block was assessed using modified Bromage scale within 24 h after the end of operation.The duration of analgesia （the time from onset of caudal block to first requirement for the rescue analgesic） and development of side effects were recorded.Results Compared with group R,the duration of analgesia was significantly prolonged,and the incidence of bradycardia and oversedation was increased in group DR.Hypoxemia,hypotension and postoperative motor block were not found in either group.Conclusion Addition of dexmedetomidine 2 μg/kg to caudal ropivacaine can significantly optimize the efficacy of caudal block with ropivacaine alone for the management of perioperative analgesia in children.

关 键 词：麻醉 脊尾 右美托咪啶 酰胺类 儿童 镇痛 

分 类 号：R726.1[医药卫生—儿科]