超声引导下骶管阻滞时加用右美托咪定对小儿发育性髋脱位矫形术术后镇痛效果的影响  

Effect of Dexmedetomidine as an Adjuvant to Ultrasound-Guided Sacral Block for Postoperative Analgesia for Children Hip Developmental Dysplasia Correction Surgery

作　　者：朱丰[1] 赵聪聪 覃倩[2] 种皓[1] 郑少强[1] 周雁[1] 王庚[1] ZHU Feng;ZHAO Congcong;QIN Qian;CHONG Hao;ZHENG Shaoqiang;ZHOU Yan;WANG Geng(Department of Anesthesiology,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Pediatric Orthopedics,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院麻醉科,北京100035 [2]北京积水潭医院小儿骨科,北京100035

出　　处：《医学综述》2019年第23期4613-4620,共8页Medical Recapitulate

摘　　要：目的观察超声引导下罗哌卡因骶管阻滞时加用右美托咪定对小儿发育性髋关节脱位(DDH)矫形术术中、术后镇痛效果及安全性的影响。方法选取2016年5月至2018年12月在北京积水潭医院小儿骨科就诊并行择期小儿DDH矫形术的46例患儿作为研究对象,依据随机数字法分为试验组和对照组,各23例。两组患儿均行静脉吸入复合全麻,均在联合超声引导下行骶管阻滞,其中试验组使用0.20%罗哌卡因+右美托咪定(剂量1μg/kg)混合液,混合液使用量为1 mL/kg;对照组单纯使用0.20%罗哌卡因,容量为1 mL/kg。在骶管注药前和注药后5、10、20、30、60、120、180 min分别记录两组患儿心率和平均动脉压(MAP),并记录两组患儿术中丙泊酚和芬太尼用量。测定术后2、4、6、12、24、36和48 h的改良面部表情评分(FLACC)以及术后首次觅求系统性镇痛药物的时间;采用Ramsay评分法评估术后拔管即刻、回病房即刻及回病房2 h后的镇静程度;记录围手术期不良反应的发生情况以及患儿家属对术后镇痛的满意度。结果试验组患儿注药后10、20、30、60 min的心率较对照组低,两组患儿注药后心率及MAP较注药前显著变化,且各时间点MAP比较差异无统计学意义(P>0.05)。试验组患儿术中丙泊酚用量明显少于对照组,两组患儿术中芬太尼用量比较差异无统计学意义(P>0.05)。试验组患儿对术后首次觅求系统性镇痛药物(乙酰氨基酚)的时间明显晚于对照组[18(16,20)h比16(12,18)h](P<0.05)。试验组患儿术后12、24 h的FLACC评分低于对照组(P<0.05);两组患儿术后12、24、36、48 h的FLACC评分均高于术后2、4、6 h(P<0.05)。所有患儿术后均未采用肌内注射盐酸哌替啶方式镇痛。试验组患儿心动过缓发生率高于对照组[30.4%(7/23)比4.3%(1/23)](P<0.05)。试验组患儿拔管后即刻镇静评分高于对照组(P<0.05),且两组患儿均未出现过度镇静。两组患儿家属对于术后�Objective To investigate the analgesic efficacy and safety of dexmedetomidine added to ropivacaine for caudal block in children with developmental dysplasia of the hip(DDH)during and after correction surgery.Methods Between May 2016 and Dec.2018,46 children with DDH undergoing selective correction surgery in Beijing Jishuitan Hospital were included in the study,and allocated into a study group(dexmedetomidine added to ropivacaine,n=23)and a control group(ropivacaine alone,n=23)according to the random number mehtod.All children received general anesthesia combined with ultrasound-guided caudal block.For children in the study group,solution of 1μg/kg dexmedetomidine combined with 0.2%ropivacaine by dosage of 1 mL/kg was used,of 0.2%ropivacaine alone by dosage of 1 mL/kg was used in the control group.Heart rate,mean arterial pressure(MAP)before caudal block and 5,10,20,30,60,120,180 min after caudal block were recorded,intraoperative propofol and fentanyl consumption were recorded.Analgesic the modified faces,legs,activity,cry and consolability(FLACC)effect at 2,4,6,12,24 and 48 h as well as time of requiring systemic analgesics for the first time after operation were recorded;Ramsay score was adopted for evaluation sedative degree while extubation,immediately and 2 h after returning to ward;the occurrence of perioperative adverse reactions and the satisfaction of children family members with postoperative analgesia were recorded.Results The heart rate at 10,20,30 and 60 minutes after injection in the study group was lower than that in the control group,the heart rate and MAP of the two groups were significantly changed after injection,and there was no significant difference in MAP at each time point(P>0.05).The amount of propofol in the test group was significantly less than that in the control group,and there was no significant difference in the amount of the intraoperative fentanyl between the two groups(P>0.05).The time of seeking systemic analgesic(acetaminophen)for the first time in the study group was signif

关 键 词：发育性髋关节脱位 骶管阻滞 右美托咪定 镇痛作用 

分 类 号：R726.8[医药卫生—儿科] R614.4[医药卫生—临床医学]