右美托咪定复合罗哌卡因在小儿髂腹下、髂腹股沟神经阻滞中的应用  

ILIOINGUINAL OR ILIOHYPOGASTRIC NERVE BLOCK WITH DEXMEDETOMIDINE COMBINED WITH ROPIVACAINE IN CHILDREN

作　　者：文江帆 蓝雨雁[1] 刘敬臣[1] 

机构地区：[1]广西医科大学第一附属医院麻醉科,南宁530021

出　　处：《广西医科大学学报》2015年第5期734-737,共4页Journal of Guangxi Medical University

基　　金：广西自然科学基金资助项目(No.2011GXNSFA018222)

摘　　要：目的:探讨右美托咪定复合罗哌卡因在小儿髂腹下、髂腹股沟神经阻滞中的镇痛效果。方法:行单侧腹股沟区手术患儿129例,随机分为3组:芬太尼组(F组,n=43),静脉注射芬太尼2μg/kg;罗哌卡因组(R组,n=43),0.25%罗哌卡因(0.4mL/kg)神经阻滞;右美托咪定复合罗哌卡因组(D组,n=43),0.25μg/kg右美托咪定+0.25%罗哌卡因(0.4mL/kg)神经阻滞。记录入室时(T0)、神经阻滞结束时/喉罩置入时(T1)、切皮时(T2)、牵拉疝囊时(T3)、缝皮结束时(T4)、苏醒时(T5)的心率(HR)、收缩压(SBP)、舒张压(DBP)、血氧饱和度(SpO2)及丙泊酚总用量、手术时间、苏醒时间、麻醉后恢复室(PACU)停留时间、苏醒期躁动、术后不良反应,并观察苏醒时(T5)、术后2h(T6)、术后4h(T7)、术后6h(T8)、术后12h(T9)和术后24h(T10)患儿的疼痛行为评分(FLACC)、术后应用镇静、镇痛药物的情况。术后24h(T10)、术后48h(T11)对患儿家长行满意度调查。结果:T3和T5时点D组和R组的HR、SBP明显低于F组,且D组T2、T3点时的SBP低于R组(P<0.05)。与T0时点比较:D组T2、T3、T5时点的HR、SBP、DBP均降低;R组T2、T3、T5时点的HR下降,T5时点的SBP下降;F组T2、T3、T5时点的HR、SBP、DBP均升高(均P<0.05)。D组和R组丙泊酚总用量、术后不良反应、术后镇静、镇痛的发生率及T5、T6、T7、T8时点FLACC评分均明显低于F组(均P<0.05);D组苏醒时期躁动的发生率、T9时点FLACC评分低于F组和R组(P<0.05)。结论:右美托咪定0.25μg/kg能显著增强0.25%罗哌卡因(0.4mL/kg)髂腹下、髂腹股沟神经阻滞的效果,减少全麻药的用量、苏醒期躁动及术后不良反应的发生,提高术后镇痛效果并延长镇痛时间。Objective：To investigate the effects of dexmedetomidine combined with ropivacaine on ilioinguinal or iliohypogastric nerve block in children undergoing inguinal surgery. Methods： One hundred and twen- ty-nine children scheduled for unilateral inguinal surgery were randomly divided into three groups： （1） fen- tanyl group （Group F, n =43）, 2 vg/kg fentanyl was administered by an intravenous injection; （2） ropiva- caine group （Group R, n =43）, 0.25% ropivacaine （0.4 mL/kg） for nerve block; （3） dexmedetomidine group （Group D, n =43）, 0.25 tlg/kg dexmedetomidine combined with 0.25~ ropivacaine （0.4 mL/kg） for nerve block. The vital signs were recorded at six time points during surgery： preanesthesia （TO）, the end of the nerve block or laryngeal mask insertion （T1）, the skin incision （T2）, pulling hernial sac （T3）, seaming the skin （T4） and recovery time （TS）. The propofol consumption, operative time, postoperative recovery time, residence time in Postanesthesia Care Unit （PACU）, agitation incidence and postoperative adverse reactions were also recorded. The Face Legs Activity Cry Consolability （FLACC） scale was used to assess the postoperative pain at recovery time （T5）, 2 h （T6）, 4 h （T7）, 6 h （T8）, 12 h （T9） and 24 h （T10） after operation. The number of children requiring postoperative analgesia was counted. Parent satis- faction level was investigated at 24 h （T10） and 48 h （Tll） after operation. Results： HR, SBP at T3 and T5 in Group D and Group R were than those in Group F （ P %0.05）. Group D was also lower than in significantly lower 0.05）. Compared with T0, at T2, SBP at T2, T3 in Group R （T2, T3 and TS, the HR,SBP and DBP in Group D were decreased; HR at T2, T3 and T5, SBP at T5 in Group R were decreased＇ at T2, T3 and T5, the HR,SBP and DBP in Group F were increased （ P〈0.05）. The propofol consumption, postoperative adverse reactions, the incidence of postoperative analgesia and FLACC scor

关 键 词：右美托咪定 罗哌卡因 神经阻滞 小儿 镇痛 

分 类 号：R614[医药卫生—麻醉学]