罗哌卡因联合地佐辛多模式镇痛在小儿唇裂修复术中的应用及其术后镇痛效果评价  

Application of multimodal analgesia of ropivacaine combined with dezocine in cheiloplasty of children and evaluation on its postoperative analgesia efficacy

作　　者：刘婕婷[1] 夏鑫[2] 申希平[3] 王迎斌[1] 

机构地区：[1]兰州大学第二医院麻醉医学中心,甘肃兰州730030 [2]兰州大学第二医院口腔科,甘肃兰州730030 [3]兰州大学公共卫生学院流行病与卫生统计学研究所,甘肃兰州730030

出　　处：《吉林大学学报（医学版）》2016年第4期807-812,共6页Journal of Jilin University：Medicine Edition

基　　金：甘肃省科技厅自然科学基金(青年科技基金)资助课题(1506RJYA227)

摘　　要：目的:探讨罗哌卡因联合地佐辛多模式镇痛的术后镇痛效果,阐明其用于唇裂修复术患儿术后镇痛的可行性。方法:采用随机、对照、双盲的试验方法,选取60例行唇裂修复术患儿,随机分为罗哌卡因组、地佐辛组和多模式镇痛组,每组20例。罗哌卡因组和多模式镇痛组患儿于手术切皮前给予0.25%罗哌卡因1.5mL行眶下神经阻滞,地佐辛组患儿给予等体积生理盐水;地佐辛组和多模式镇痛组患儿于术毕前20min静脉注射地佐辛0.15mg·kg-1,罗哌卡因组患儿注射等体积生理盐水。记录各组患儿年龄、体质量、麻醉和手术时间;记录苏醒、拔管时间、苏醒期躁动评分及发生率、有无喉和支气管痉挛;记录术后2、4、6、8、12和24hCRIES评分;记录术后不良反应发生情况。结果:3组患儿年龄、体质量、麻醉和手术时间比较差异无统计学意义(P>0.05)。多模式镇痛组和地佐辛组患儿苏醒、拔管时间长于罗哌卡因组(P<0.05),苏醒期躁动评分、躁动发生率3组间比较差异无统计学意义(P>0.05),均未发生喉及支气管痉挛。多模式镇痛组患儿术后2hCRIES评分最低,与其他2组比较差异有统计学意义(P<0.05);地佐辛组患儿术后4hCRIES评分较术后2h有所升高,罗哌卡因组和多模式镇痛组患儿术后4hCRIES评分低于地佐辛组(P<0.05);多模式镇痛组患儿术后6hCRIES评分仍最低,与其他2组比较差异有统计学意义(P<0.05),罗哌卡因组患儿术后6h CRIES评分较术后4h时有所升高,但与地佐辛组比较差异无统计学意义(P>0.05);术后8、12和24h CRIES评分3组间比较差异无统计学意义(P>0.05)。多模式镇痛组患儿心动过速发生率最低,使用镇痛药例数最少,与其他2组比较差异有统计学意义(P<0.05),3组患儿均未发生呼吸抑制。结论:罗哌卡因联合地佐辛多模式镇痛可有效延长患儿术后镇痛持续时间,减少术后不良反应,可安全用于唇裂修复术患儿的术�Objective：To discuss the postoperative analgesia efficacy of multimodal analgesia of ropivacaine combined with dezocine,and to illuminate the feasibility of multimodal analgesia in the children undergoing cheiloplasty.Methods：In the randomized,controlled and double blind study,sixty children scheduled for cheiloplasty were randomly divided into ropivacaine group,dezocine group and multimodal analgesia group（n=20）.The children in ropivacaine group and multimodal analgesia group were treated with infraobital nerve blockade（1.5mL 0.25% ropivacaine）before skin incision.The children in dezocine group received the same volume of normal saline. The patients in dezocine group and the multimodal analgesia group received dezocine（0.15mg·kg^-1）20 min before the end of operation,and the children in ropivacaine group received the same volume of normal saline.The children＇s ages and weights,duration of anesthesia and operation,reviving and extubation time,agitation score and incidence,laryngospasm or bronchospasm,CRIES scores at 2,4,6,8,12,and 24 hafter operation and adverse reactions were all recorded.Results：There were no significant differences in the age,weight,the duration of anesthesia and operation of the children between three groups（P〉0.05）.Compared with ropivacaine group,the reviving and extubation time of the children in dezocine group and multimodal analgesia group were increased（P〈0.05）.There were no significant differences in the scores and the incidence of agitation between three groups（P〉0.05）.There were no laryngospasm or bronchospasm occured in all groups.The CRIES score at 2hafter operation of the children in multimodal analgesia group was the lowest and there were significant differences compared with other two groups（P〈0.05）.The CRIES score at 4hafter operation of dezocine group was increased compared with 2hafter operation and was higher than other two groups（P〈0.05）.The CRIES score at 6hafter operation of the children in multimodal analgesia group was ye

关 键 词：罗哌卡因 地佐辛 多模式镇痛 唇裂修复术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学] R782.21[医药卫生—外科学]