右美托咪定非静脉给药途径在儿科下腹手术术后镇痛的应用  

Application of Dexmedetomidine with Non-intravenous Route in Postoperative Analgesia in Pediatric Patients Undergoing Abdominal Surgery

作　　者：曹雪峰[1] 赵亮[2] 刘旭东[3] 姜亚男 刘玉伶[1] 李艳[1] 

机构地区：[1]承德医学院附属医院,河北承德067000 [2]承德医学院,河北承德067000 [3]河北省承德市中心医院,河北承德067000 [4]河北省隆化县中医院,河北隆化068150

出　　处：《河北医学》2017年第11期1828-1833,共6页Hebei Medicine

基　　金：2015年承德市科学技术研究与发展计划项目;(编号:20157057)

摘　　要：目的:研究右美托咪定非静脉给药途径在儿科下腹术后镇痛的应用。方法:搜集我院儿科拟行下腹择期手术的患儿60例,随机分为A、B、C三组,每组各20例。B组于术前30min右美托咪定1ug/kg滴鼻,A,C组等容积生理盐水滴鼻。三组患儿均给于阿托品0.01~0.02mg/kg,利多卡因1mg/kg,丙泊酚2mg/kg,七氟醚6~8%,氧流量2L/min,待患儿睫毛反射消失置入喉罩,将七氟醚降到1~2%。A组和B组患儿骶管阻滞成功后注入0.25%罗哌卡因1m L/kg,C组给予0.25%罗哌卡因1m L/kg+右美托咪定1ug/kg,骶管阻滞给予药物总量20m L封顶。记录患儿的一般资料。记录手术时间,诱导时间,拔喉罩时间和苏醒时间。记录心动过缓、苏醒延迟、喉痉挛、尿储留和苏醒期躁动评分。记录术后4,8,12,16,20,24h镇痛评分,镇静评分,计算各组镇痛时间。结果:三组患儿一般状况差异无统计学意义(P>0.05)。三组手术时间,拔喉罩时间,苏醒时间差异不存在统计学意义(P>0.05),B组的诱导时间短于A组和C组(P<0.05)。三组患儿均无心动过缓、苏醒延迟和尿储留的发生,A组喉痉挛的发生和躁动评分高于B和C组,B,C组的镇痛时间比A组延长,C组最长(P<0.05)。术后4h镇痛评分均小于4分,镇静评分为2~3分,B,C组8h的镇痛镇静评分低于A组(P<0.05),C组12,16,20h的镇静,镇痛评分低于A,B组(P<0.05);术后24h镇痛镇静评分差异无统计学意义(P>0.05)。结论:右美托咪啶滴鼻给药诱导迅速且有早期术后镇痛镇静的作用,右美复合罗哌卡因骶管阻滞术后镇痛时间明显延长,苏醒期不良反应明显减少。Objective: To investigate the effect of dexmedetomidine intravenous administration on postoperative analgesia in pediatric patients undergoing abdominal surgery. Methods: 60 patients who were undergoing the general anesthesia for lower abdomen surgery were randomly devided into there groups,each group20 cases. Patients in group B were received dexmedetomidine 1 ug/kg nasal drops before operation 30 min; Patients in group A,C were received volume normal saline nasal drops. The three groups were given atropine 0.01-0.02 mg/kg,lidocaine 1 mg/kg,propofol 2 mg/kg,sevoflurane 6-8%,oxygen flow 2 L/min,waiting for the eyelash reflex disappeared,placed the laryngeal mask,sevoflurane dropped to 1-2%. In group A and group B,0.25% ropivacaine 1 ml/kg was injected after the success of sacral block,group C was given 0.25%ropivacaine 1 ml/kg+ dexmedetomidine 1 ug/kg,sacral block was given total amount of 20 ml cap. 1. Each patient general information respectively were record; 2. The time of operation,induction,extubation and anesthesia awake were recorded; 3. The adverse events such as bradycardia,delayed awakening,laryngismus,urine retention were and awakening period agitation score were recorded. 4. Postoperative 4,8,12,16,20,24 hours analgesic score,sedation score and analgesia time were recorded. Results: 1. The general situation have no statistical significance( P >0.05); 2. The time of operation,extubation and anesthesia awake have no statistical significance( P >0.05),the induction time of B group are shorter than A and C groups( P <0.05); 3.All the three groups have no hypoxemia,delayed awakening and urine retentionwere; Compared with group B and C,the emergence laryngismus and awakening period agitation score were higher in group A( P < 0.05);the analgesia time were shorter,group C was the longest. 4. All the analgesic score of the three groups were less than 4 points,sedation score for 2-3 minute in postoperative 4 h. Compared with group A,analgesic and sedation score of the group B and C are lower in postoperative 8

关 键 词：右美托咪啶 滴鼻 骶管阻滞 儿科 术后镇痛 

分 类 号：R726.1[医药卫生—儿科]