右美托咪定联合氢吗啡酮在脑瘫儿术后静脉自控镇痛中的运用价值  

Application Value of Dexmedetomidine Combined with Hydromorphone in Postoperation Patient-Controlled Intravenous Analgesia of Cerebral Palsy Children

作　　者：夏敏[1] 周旺辉[1] 王凌[1] Xia Min;Zhou Wanghui;Wang Lin(Jingmen First People′s Hospital,Jingmen,Hubei 448000,China)

机构地区：[1]荆门市第一人民医院麻醉科,湖北荆门448000

出　　处：《四川医学》2018年第10期1159-1162,共4页Sichuan Medical Journal

基　　金：湖北省荆门市科技支撑计划项目(编号:YDKY2016007)

摘　　要：目的探讨右美托咪定联合氢吗啡酮在脑瘫儿术后静脉自控镇痛中的运用价值。方法将86例脑瘫患儿分为研究组和对照组,每组43例。全部患儿进行功能性选择性脊神经后根切断术治疗,术后采用静脉自控镇痛(PICA)进行镇痛。研究组采用右美托咪定联合氢吗啡酮的方案。对照组单纯采用氢吗啡酮的方案。对比两组患儿的手术情况。于术毕(T0)、术后1h(T1)、术后6h(T2)、术后12h(T3)、术后24h(T4),记录两组患儿HR、MAP、SpO_2的水平变化。采用婴幼儿术后疼痛评估量表(CRIES评分)评估患者疼痛变化。采用镇静评分标准(Ramsay评分)评估患儿术后镇静程度。结果两组的手术时间、手术失血量、麻醉时间、苏醒时间对比,差异无统计学意义(P>0.05);研究组的氢吗啡酮剂量、按压次数明显低于对照组,差异有统计学意义(P<0.05);在T0～T4的时间点,两组的HR、MAP、SpO_2组间对比,差异无统计学意义(P>0.05);在T0～T4的时间点,两组的CRIES评分明显升高,差异有统计学意义(P<0.05);在T0～T4的时间点,研究组的Ramsay评分无明显变化,差异无统计学意义(P>0.05);对照组的Ramsay评分明显升高,且明显高于同期的研究组,差异有统计学意义(P<0.05);研究组的不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。结论脑瘫儿术后静脉自控镇痛采用右美托咪定联合氢吗啡酮的方案,具有较好的镇痛和镇静效果,且不良反应低。Objective To discuss the application value of dexmedetomidine combined with hydromorphone in postoperation patient-controlled intravenous analgesia of cerebral palsy children.Methods 86 cases of cerebral palsy were divided into study group and control group,with 43 cases in each group.All the children were treated with functional selective posterior rhizotomy and postoperative patient-controlled intravenous analgesia(PICA)was used for analgesia.The study group was used dexmedetomidine combined with hydromorphone.The control group was treated with hydromorphone alone.The operating conditions of the two groups were compared.The levels of HR,MAP and SpO2 of two groups after operation(T0),postoperation 1h(T1),6h(T2),12h(T3)and 24h(T4)were recorded.Infant postoperative pain assessment scale(CRIES Score)was used to evaluate the patient s pain change.Sedation score(Ramsay score)was used to assess the degree of postoperative sedation of children.Results The differences between the two groups in operation time,bleeding volume,anesthesia time,awaken time were not statistically significant(P>0.05).In the study group,the hydromorphone dosage and pressure times were significantly lower than those of the control group and the differences were statistically significant(P<0.05).At the time point between T0 and T4,there were no statistically significant differences between the two groups in HR,MAP and SpO 2(P>0.05).At the time point between T0 and T4,the CRIES score of the two groups were significantly increased and the difference was statistically significant(P<0.05).At the time point between T0 and T4,there was no significant change in the Ramsay score of the study group,and the difference was no statistical significance(P>0.05).The Ramsay score of the control group was increased obviously and significantly higher than that of the study group,and the difference was statistically significant(P<0.05).The incidence of adverse reactions in the study group was significantly lower than that in the control group,and the difference was

关 键 词：右美托咪定 氢吗啡酮 脑瘫 静脉自控镇痛 镇静 镇痛 

分 类 号：R74[医药卫生—神经病学与精神病学] R72[医药卫生—临床医学]