静脉输注利多卡因对腹腔镜疝修补术患儿苏醒期躁动的临床观察  

Effects of Single Dose of Lidocaine on Agitation in Pediatric Patient undergoing Laparoscopic Hernia Repair:A Clinical Observation

作　　者：许冬妮[1] 刘婷[1] 王培宗[2] 卢桠楠[1] XU Dong-ni;LIU Ting;WANG Pei-zong;LU Ya-nan(Department of Anesthesiology,Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China;Department of Anesthesiology,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]中山大学孙逸仙纪念医院麻醉科,广东广州510120 [2]中山大学肿瘤防治中心麻醉科,广东广州510060

出　　处：《中山大学学报（医学科学版）》2021年第5期783-789,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(2021A1515012357)。

摘　　要：【目的】观察静脉输注利多卡因对腹腔镜疝修补术患儿苏醒期躁动的影响。【方法】选择年龄在2~4岁之间,美国麻醉医师协会体格分级(ASA)Ⅰ~Ⅱ级择期在全麻下行腹腔镜疝修补术的患儿60例为研究对象,按照随机数字表法分为空白对照组(C组),右美托咪定阳性对照组(D组),利多卡因处理组(L组),每组20例。主要观察指标包括WATCHA量表躁动评分,拔管后躁动发生率,补救加药次数;次要观察指标包括术中平均七氟烷吸入浓度,术后早期疼痛评分,拔管时间,恢复室停留时间,48h内术后镇痛药物曲马多使用量,【结果】①D组、L组患儿术后WATCHA躁动评分均低于C组;D组、L组患儿躁动发生率分别为15%、20%,均低于C组70%;补救加药人次均为10%,低于C组55%;采用Bonferroni校正,两两对比差异有统计学意义(P<0.017)。②D组和L组患儿,术中平均七氟醚吸入浓度低于C组;L组拔管时间(12.05±2.96)min低于D组;恢复室停留时间(51.50±9.61)min最短,少于D组和C组,Bonferroni校正后两两对比,差异有统计学意义(P<0.017)。③D组和L组患儿术后48 h曲马多用量和术后24 h新发适应不良发生率少于C组,Bonferroni校正后两两对比,差异有统计学意义(P<0.017)。④D组和L组HR2、HR3和HR4均低于C组,Bonferroni校正后两两对比,差异有统计学意义(P<0.017)。【结论】静脉输注利多卡因或右美托咪定都可以减少腹腔镜疝切除术患儿术后躁动的发生,静脉输注利多卡因或右美托咪定都可以减少术中七氟醚的用量,以及减少术后镇痛药物的用量,降低术后新发适应不良的发生率,且围术期心率更稳定。与右美托咪定相比,利多卡因组有更短的拔管时间和恢复室停留时间,复苏更快。【Objective】To investigate the effects of single dose of intravenous infusion Lidocaine on emergence agitation in small children undergoing laparoscopic hernia repair.【Methods】A total of 60 children aged 2 to 4 years with ASA Ⅰ-Ⅱgrades undergoing laparoscopic hernia repair under general anesthesia were selected as the research objects.According to the random number table,they were divided into a complete blank control group(group C)and a positive control,Dexmedetomidine group(D group),lidocaine group(L group),20 cases in each group.The primary outcome measures include the WATCHA scale agitation score,the incidence of agitation after extubation,and the rescue medication times.The secondary observation indicators include the average sevoflurane inhalation concentration during the operation,the early postoperative analgesia score,extubation time,time stay in PACU,the total amount of tramadol.【Results】①The postoperative WATCHA agitation scores of children in group D and L were lower than those in group C;the incidence of agitation in children in group D and L was 15%and 20%,respectively,which were both lower than 70%in group C;remedy plus The number of drug users was 10%,which was 55%lower than that of group C;with Bonferroni correction,the difference between pairwise comparisons was statistically significant(P<0.017).②In the children of group D and L,the average inhalation concentration of sevoflurane during operation was lower than that of group C;The extubation time of group L(12.05±2.96)min was lower than that of group D;the residence time in the recovery room(51.50±9.61)min was the shortest.Less than D and C groups,after Bonferroni adjustment,the difference was statistically significant(P<0.017).③The incidence of tramadol dosage at 48 hours postoperatively and the incidence of new maladaptation at 24 hours postoperatively in group D and group L were lower than those in group C.After Bonferroni correction,the difference was statistically significant(P<0.017).④HR 2,HR 3 and HR 4 of group D

关 键 词：腹腔镜疝修补术 利多卡因 右美托咪定 躁动 

分 类 号：R441.1[医药卫生—诊断学]