右美托咪定用于新生儿幽门环肌切开术后镇痛的观察  

Observation on analgesia of dexmedetomidine in neonates after pylorotomy

作　　者：程丽群[1] 余树春[2] CHENG Liqun;YU Shuchun(Department of anesthesiology,Children's Hospital Affiliated to Nanchang University,Nanchang 330006,China;Department of Anesthesiology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006 China.)

机构地区：[1]南昌大学附属儿童医院麻醉科,南昌330006 [2]南昌大学第二附属医院麻醉科,南昌330006

出　　处：《江西医药》2020年第6期665-668,705,共5页Jiangxi Medical Journal

摘　　要：目的观察右美托咪定(dexmededetomidine,Dex)复合左旋布比卡因骶管阻滞在新生儿幽门环肌切开术术后镇痛中的作用。方法采用随机数字表法将40例行腹腔镜下幽门环肌切开术的新生儿分为两组(每组20例):对照组(B组),以0.25%左旋布比卡因共计1ml/kg超声引导下行骶管阻滞;试验组(DB组),以右美托咪定1μg/kg复合0.25%左旋布比卡因共计容积1ml/kg在超声引导下行骶管阻滞。分别记录每组患儿术后不同时间点(T1术后1h、T2术后4h、T3术后8h、T4术后12h、T5术后24h)的生命体征数据(HR、MAP、SPO2)、镇痛评分及镇静评分,依据CRIES(Crying,Requires O2 saturation,Increased vital signs,Expression,Sleeplessness)评分标准和Ramsay评分准则综合评估术后镇痛、镇静评分。记录患儿术后开始出现疼痛时间的无痛时间(T-pain free)、疼痛即刻(T-pain)CRIES评分。结果DB组术后各个时间点HR均显著低于B组;DB组在T3及T4时MAP较B组相应时间点显著降低:[(62±2)mmHg比(65±5)mmHg、(63±1)mmHg比(66±8)mmHg](P<0.05);DB组患儿术后各个时间点CRIES评分明显低于相应时间点B组患儿[(0.9±0.6)分比(1.1±0.5)分、(1.1±0.3)分比(1.7±0.4)分、(1.2±0.4)分比(3.1±0.6)分、(1.9±0.4)分比(4.5±0.8)分、(2.3±0.7)分比(2.9±0.9)](P<0.05);DB组患儿术后T1、T2、T3、T4时间点Ramsay评分明显高于相应时间点B组患儿[(4.2±0.5)分比(2.2±0.4)、(3.9±0.7)分比(1.1±0.3)分、(3.6±0.6)分比(1.0±0.2)分、(3.1±0.2)分比(0.8±0.3)分](P<0.05),DB组患儿T5时间点Ramsay评分比较B组患儿无明显升高[(2.1±0.3)分比(1.9±0.5)分](P>0.05);DB组患儿术后开始出现疼痛时间的无痛时间(T-pain free)较B组明显增加:[(12.5±1.3)h比(6.7±0.6)h](P<0.05);DB组疼痛即刻疼痛评分明显低于B组:[(1.9±0.4)分比(3.1±0.4)分](P<0.05)。结论与单独使用左旋布比卡因骶管阻滞相比,Dex复合左旋布比卡因骶管阻滞在新生儿幽门环肌切开术术后镇痛中能显著减轻患儿Objective To observe the effect of dexmededetomidine(Dex)combined with levobupivacine in the postoperative analgesia of neonatal pyloric ring myotomy.Methods Forty neonates undergoing laparoscopic pyloric ring myotomy were randomly divided into two groups(20 cases in each group):the control group(group B)was treated with 0.25%levobupivacaine for a total of 1ml/kg ultrasound-guided sacral block;and the experimental group(DB group),was treated with dexmedetomidine(1ug/kg combined with 0.25%levobupivacaine)with a total volume of 1ml/kg ultrasound-guided sacral block.Different time points recorded in each group separately posyoperative(T1 posyoperative 1h,T2 posyoperative 4h,T3 posyoperative 8h,T4 posyoperative 12h,T5 posyoperative 24h.)after vital signs data(HR,MAP,SPO2),pain score and sedation score,on the basis of CRIES(Crying,the Requires O2 saturation,Increased vital signs,Expression,Sleeplessness)criteria and Ramsay comprehensive evaluation of postoperative analgesia,sedation score grading standards.T-pain free and t-pain immediate pain score were recorded.Results HR in DB group was significantly lower than that in the group B at all postopertive time points.In T3 and T 4,MAP in DB group was significantly lower than that in group B at corresponding time points:[(60±2)mmHg vs(68±5)mmHg,(61±1)mmHg vs(69±8)mmHg].The CRIES score of children in DB group was significantly lower than that in group B at each time point[(0.9±0.6)points vs(1.1±0.5)points,(1.1±0.3)points vs(1.7±0.4)points,(1.2±0.4)points vs(3.1±0.6)points,(1.9±0.4)points vs(4.5±0.8)points,(2.3±0.7)points vs(2.9±0.9)points](P<0.05).The Ramsay scores at T1,T2,T3 and T4 were significantly higher in the DB group than those in group B at the corresponding time point[(4.2±0.5)vs(2.2±0.4)points,(3.9±0.7)vs(1.1±0.3)points,(3.6±0.6)vs(1.0±0.2)points,(3.1±0.2)vs(0.8±0.3)points](P<0.05).Compared with B group,t-pain free was significantly increased in the DB group:[(19.5±1.3)h vs(6.7±0.6)h](P<0.05).Immediate pain score in the DB group was sign

关 键 词：右美托咪定 左旋布比卡因 骶管阻滞 新生儿幽门环肌切开术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]