罗哌卡因局部封闭麻醉对小儿疝气术后康复的作用  

Function of The Regional Blockade with Ropivacaine on The Enhanced Recovery after Surgery of Pediatric Patients with Hernias

作　　者：杨慧菊[1] 于冬男[1] 马珏[1] 胡世雄[1] 张登文[1] 王晟[1] YANG Hui-ju;YU Dong-nan;MA Jue;HU Shi-xiong;ZHANG Deng-wen;WANG Sheng(Department of Orthopedics,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省人民医院麻醉科广东省医学科学院,广州510080

出　　处：《循证医学》2017年第3期171-174,共4页The Journal of Evidence-Based Medicine

摘　　要：目的探讨罗哌卡因局部封闭麻醉对小儿疝囊高位结扎术后康复的作用。方法采用随机、单盲、平行对照的方法,将行小儿疝囊高位结扎术患者分为试验组和对照组,对照组30人,常规静脉全身麻醉,手术结束后予0.9%生理盐水2~3 m L局部注射;试验组50人,常规静脉全身麻醇,手术结束后予0.2%罗哌卡因2~3 m L局部封闭。记录并分析两组患者术后2 h、6 h、12 h的疼痛视觉模拟评分,术后复苏室的生命体征,术后使用对乙酰氨基酚栓剂剂量、下地活动时间、住院时间。结果试验组患者术后2 h、6 h、12 h的疼痛视觉模拟评分均低于对照组[(1.3±1.15)vs.(6.8±0.76),(1.46±1.09)vs.(7.1±0.84),(1.52±1.15)vs.(7.33±1.06),P<0.001],术后使用对乙酰氨基酚栓剂剂量少于对照组(c2=45.38,P<0.001),术后下地活动时间少于对照组[(9.84±1.39)h vs.(12.20±1.47)h,t=-7.19,P<0.001],住院时间少于对照组[(29.32±4.69)h vs.(38.93±4.29)h,t=-9.16,P<0.001]。结论罗哌卡因局部封闭麻醉对小儿疝囊高位结扎术后能有效镇痛,减少术后止痛药物的使用剂量,促使患儿更早下床活动,缩短住院时间,是一种值得推荐的临床方法。Objective We aimed to discuss the effect of regional blockade with Ropivacaine on the enhancedrecovery after surgery(ERAS)of pediatric patients who went through hernial sac high ligation.Methods This was arandomized,single-blind,parallel controlled trial.Children who went through hernial sac high ligation were divided intothe study group and control group.A total of30children were included into the control group and total intravenousanesthesia was routinely implemented for all of them.A dose of2~3mL0.9%normal saline was locally injectedpostoperatively.On the other hand,a total of50children were included into the study group and total intravenousanesthesia was also routinely implemented for them.A dose of2~3mL0.2%Ropivacaine was locally injectedpostoperatively.Visual analog scale(VAS)scores of the two groups2hours,6hours,and12hours postoperatively wererecorded.The changes in vital signs at the post-anesthesia care unit(PACU),the doses of paracetamol(suppositories)postoperatively,time to ambulation,and length of hospital stay were recorded and compared between the two groups.Results VAS scores2hours[(1.3±1.15)vs.(6.8±0.76)],6hours[(1.46±1.09)vs.(7.1±0.84)],and12hours[(1.52±1.15)vs.(7.33±1.06)]postoperatively of the study group were all significantly lower than the control group(P<0.001).Besides,children from the study group had less postoperative paracetamol(suppositories)doses(c2=45.38,P<0.001),earlier ambulation[(9.84±1.39)h vs.(12.20±1.47)h,P<0.001],and shorter length of hospital stay[(29.32±4.69)h vs.(38.93±4.29)h,P<0.001]than children from the control group.Conclusions For children undergoing hernial high sac ligation,regional blockade with Ropivacaine can effectively ease pain,reduce the dose of postoperativeanalgesics,prompt earlier ambulation,shorten the length of hospital stay,and thus is a recommendable clinicalapproach.

关 键 词：罗哌卡因 疝气 镇痛 疝囊高位结扎术 

分 类 号：R726.1[医药卫生—儿科]