右美托咪定镇静复合罗哌卡因骶管阻滞用于新生儿会阴肛门成形术的效果  

Efficacy of dexmedetomidine sedation combined with ropivacaine caudal block for perineal anoplasty in neonates

作　　者：魏晓永[1] 刘茜 徐玲兰 董正华[1] 赵军博[1] 刘博[1] 姜丽华[1] WEI Xiao-yong;LIU Xi;XU Ling-lan;DONG Zheng-hua;ZHAO Jun-bo;LIU Bo;JIANG Li-hua(Department of Anesthesiology,the Third Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院麻醉科,450052

出　　处：《天津医药》2021年第9期973-976,共4页Tianjin Medical Journal

摘　　要：目的观察右美托咪定镇静复合罗哌卡因骶管阻滞用于新生儿会阴肛门成形术的效果。方法选取择期行会阴肛门成形术患儿80例,根据随机数字表法分为右美托咪定组(D组)和对照组(C组)。D组患儿给予负荷剂量右美托咪定1μg/kg(泵注时间大于10 min),Ramsay评分3~4分时左侧卧位下骶管穿刺注入0.2%罗哌卡因1 mL/kg,术中持续泵注右美托咪定0.2~1μg/(kg·h)维持Ramsay评分3~4分。C组患儿静脉麻醉诱导,气管插管成功后左侧卧位下骶管穿刺,成功后注入0.2%罗哌卡因1 mL//kg。记录2组患儿入手术室时(T_(0))、手术开始时(T_(1))、肛周固定时(T_(2))、手术结束时(T_(3))、出手术室时(T_(4))心率、平均动脉压和血氧饱和度;记录麻醉时间、手术时间和苏醒时间、手术室内低氧血症发生情况,术中、苏醒期及麻醉复苏室(PACU)停留期间呼吸抑制、呼吸暂停、呛咳、喉痉挛、支气管痉挛及骶管阻滞相关并发症发生情况。结果与C组相比,D组T_(1)、T_(2)、T_(3)、T_(4)时心率降低,平均动脉压升高,T_(2)、T_(3)时血氧饱和度降低(P<0.05)。D组苏醒时间明显短于C组(P<0.05)。与C组相比,D组苏醒期间呼吸抑制/暂停、呛咳、喉痉挛、支气管痉挛及PACU停留期间呼吸抑制/暂停发生率显著降低(P<0.05)。结论右美托咪定镇静复合罗哌卡因骶管阻滞用于新生儿会阴肛门成形术安全有效。Objective To evaluate the efficacy of dexmedetomidine sedation combined with ropivacaine caudal block in perineal anoplasty in neonates.Methods Eighty neonates scheduled for elective perineal anoplasty were divided into 2 groups(n=40 each)using a random number table:dexmedetomidine group(D group)and control group(C group).In group D,dexmedetomidine was given at a bolus dose of 1μg/kg over 10 min.When the Ramsay score reached 3-4,caudal anesthesia was performed using a single dose of 0.2%ropivacaine 1 mL/kg in the left lateral position.Sedation was maintained with dexmedetomidine infusion at the rate of 0.2-1μg/(kg·h)to maintain a Ramsay score of 3-4 and discontinued at the end of surgery.Neonates in group C were induced by intravenous anesthesia,after tracheal intubation,caudal anesthesia was performed using a single dose of 0.2%ropivacaine 1 mL/kg in the left lateral position.Heart rate,percutaneous oxygen saturation and mean arterial pressure were recorded at the following times:into the operation room(T_(0)),at the beginning of the operation(T_(1)),fixation of the perianal(T_(2)),at the end of the operation(T_(3))and out of the operation room(T_(4)).Data of anesthesia time,operation time and recovery time,the incidence of hypoxemia in the operating room,respiratory depression/suspension,cough,laryngospasm,bronchospasm and sacral block related complications during the operation,recovery and stay in the anesthetic resuscitation room(PACU)were recorded.Results Compared with group C,heart rate decreased and mean arterial pressure increased at T_(1),T_(2),T_(3) and T_(4),and oxygen saturation decreased at T_(2) and T_(3) in group D(P<0.05).The recovery time was significantly shorter in group D than that of group C(P<0.05).Compared with group C,the incidence of respiratory depression/suspension,cough,laryngospasm,bronchospasm and stay in PACU were significantly lower in group D than that in group C(P<0.05).Conclusion Dexmedetomidine sedation combined with ropivacaine caudal block is safe and effective in neonates

关 键 词：麻醉 脊尾 婴儿 新生 右美托咪定 罗哌卡因 会阴肛门成形术 

分 类 号：R614[医药卫生—麻醉学]