超声引导下腰丛神经或骶管阻滞在小儿髋关节矫形术后镇痛中的应用分析  

Application Analysis of Ultrasound-guided Lumbar Plexus Block or Sacral Block in Postoperative Analgesia for Pediatric Hip Orthormorphia

作　　者：冯宝莹[1] FENG Baoying(Foshan Hospital of TCM,Foshan 528000,China)

机构地区：[1]广东省佛山市中医院,广东佛山528000

出　　处：《中国医学创新》2017年第36期34-37,共4页Medical Innovation of China

摘　　要：目的:比较在小儿髋关节矫形术后镇痛中超声引导下腰丛神经与骶管阻滞麻醉的应用效果。方法:选取2015年6月-2017年6月在本院治疗的先天性髋关节脱位患儿82例,按照随机数字表法将其分为腰丛阻滞组(采用Winnie三叶草腰丛阻滞)和骶管阻滞组(采用罗哌卡因骶管阻滞),各41例,两组均在超声引导下进行,局麻药物选择0.2%罗哌卡因1 m L/kg。比较两组超声定位时间、区域麻醉时间、总麻醉时间;术中芬太尼用量、首次使用PCA时间及PCA吗啡总用量;术后疼痛评分(CHEOPS评分);麻醉不良反应发生情况。结果:腰丛阻滞组的超声定位时间显著短于骶管阻滞组(P<0.05);腰丛神经组术后CHEOPS评分低于骶管阻滞组(P<0.05),其中腰丛神经组≥3分9例(21.95%);骶管阻滞组19例(46.34%),比较差异有统计学意义(P<0.05);腰丛阻滞组首次使用PCA时间显著晚于骶管阻滞组,PCA吗啡总用量显著低于骶管阻滞组(P<0.05);两组区域麻醉时间、总麻醉时间、术中芬太尼用量、麻醉不良反应(术中低血压、心动过缓及术后恶心呕吐)比较,差异均无统计学意义(P>0.05)。结论:相对于骶管阻滞,超声引导下腰丛神经阻滞对髋关节矫形术后患儿镇痛效果更好,且镇痛时间更长,故提倡使用。Objective:To compare the effect of ultrasound-guided lumbar plexus block and sacral block anesthesia in postoperative analgesia of pediatric hip orthormorphia.Method:A total of 82 children with congenital dislocation of the hip joint treated in our hospital from June 2015 to June 2017 were selected,according to the random number table method,they were divided into lumbar plexus block group(Winnie clover lumbar plexus block)and sacral block group(Ropivacaine sacral block),41 cases in each group,they were performed under the guidance of ultrasound,and the local anesthetic drugs were 0.2%Ropivacaine 1 mL/kg.The location time of ultrasound,regional anesthesia time,total anesthetic time,the dosage of fentanyl,the first time to use PCA and the total dosage of PCA Morphine,the postoperative pain score(CHEOPS score)and the incidence of adverse reactions after anesthesia were compared between two groups.Result:The location time of ultrasound in lumbar plexus block group was significantly shorter than that of sacral block group(P<0.05),the CHEOPS score after operation in lumbar plexus block group were lower than that of sacral block group(P<0.05),the scores of CHEOPS more than 3 points in lumbar plexus group was 9 cases(21.95%),and sacral block group was 19 cases(46.34%),the difference was statistically significant(P<0.05),the first time to use PCA in lumbar plexus block group was significantly later than sacral block group,and the total dosage of PCA Morphine was significantly lower than that of sacral anesthesia group(P<0.05).The regional anesthesia time,total anesthetic time,the dosage of fentanyl and the incidence of adverse reactions after anesthesia(intraoperative hypotension,bradycardia and postoperative nausea and vomiting)between two groups were compared,the differences were not statistically significant(P>0.05).Conclusion:The analgesic effect of ultrasound-guided lumbar plexus block for children after hip orthormorphia is better than that of sacral canal block,and the time of analgesia is longer,so it is advocate

关 键 词：小儿髋关节矫形术 超声 腰丛神经阻滞 骶管阻滞 镇痛效果 

分 类 号：R726.1[医药卫生—儿科]