右美托咪定复合罗哌卡因髂腹下神经阻滞对小儿斜疝手术及肠道功能的影响  

Effects of dexmedetomidine combined with ropivacaine iliohypogastric nerve block on the intestinal function of children with indirect inguinal hernia undergoing operation

作　　者：王婵 邓超文 禹枫 陈付贵 赵瑞媚 WANG Chan;DENG Chaowen;YU Feng(Department of Anesthesiology,Hunan Aerospace Hospital,Hunan,Changsha 410006,China;不详)

机构地区：[1]湖南航天医院麻醉科,长沙市410006 [2]湖南中医药大学附属第一医院麻醉手术科

出　　处：《河北医药》2022年第11期1638-1641,共4页Hebei Medical Journal

摘　　要：目的探讨右美托咪定(DEX)复合罗哌卡因髂腹下神经阻滞对小儿斜疝手术及肠道功能的影响。方法选择2019年10月至2020年10月行腹股沟斜疝术的68例患儿为研究对象,按照随机数字表法将其分为研究组和对照组,每组34例。研究组患儿给予罗哌卡因1 mg/kg复合DEX 1μg/kg髂腹下神经阻滞,对照组患儿给予罗哌卡因1 mg/kg髂腹下神经阻滞。记录患儿入室时(T1)、切皮时(T2)、切皮后10 min(T3)、缝皮时(T4)、苏醒时(T5)的HR、MAP、血氧饱和度(SPO_(2))变化情况;采用中文版儿童疼痛行为量表(FLACC)评估患儿术后2 h、4 h、6 h、12 h、24 h评分,记录患儿术后镇痛药物使用情况;术前及术后24 h分别采用高效液相色谱测定患儿尿乳果糖/甘露醇(L/M)值,酶联免疫法测定患儿尿液尿肠型脂肪酸结合蛋白(IFABP)。结果2组患儿T3~T5时点HR、MAP呈下降趋势,其中研究组T3~T5时点HR、MAP值低于对照组,差异有统计学意义(P<0.05)。2组患儿术后各时点FLACC呈下降趋势,其中研究组各时点FLACC评分值低于对照组,差异有统计学意义(P<0.05),术后使用镇痛药物研究组患儿8例,对照组患儿18例,研究组患儿术后使用镇痛药物使用率低于对照组患儿(χ^(2)=6.227,P=0.013);术后2组患儿L/M、IFABP均较术前升高,其中研究组患儿L/M、IFABP均低于对照组,差异有统计学意义(P<0.05)。结论DEX复合罗哌卡因可增强小儿斜疝手术髂腹下神经阻滞效果,延长术后镇痛时间,对患儿术后肠黏膜屏障功能损伤具有一定改善作用。Objective To investigate the effects of dexmedetomidine(DEX)combined with ropivacaine iliohypogastric nerve block on the intestinal function of children with indirect inguinal hernia undergoing operation.Methods A total of 68 children patients with indirect inguinal hernia who were treated by surgery in our hospital from October 2019 to October 2020 were enrolled in the study,who were randomly divided into research group and control group,with 34 cases in each group.The patients in research group were given ropivacaine 1mg/kg combined with DEX 1μg/kg iliac hypogastric nerve block,however,those in control group were given ropivacaine 1mg/kg iliohypogastric nerve block.The changes of HR,MAP and blood oxygen saturation(SPO_(2))at the time of admission(T1),skin incision(T2),10 minutes after skin incision(T3),suture(T4)and awakening(T5)were recorded.The postoperative scores at 2h,4h,6h,12h and 24h were evaluated by FLACC,and the usage amount of sedative and analgesic drugs was recorded.Urinary lactulose/mannitol(L/M)values were measured by high performance liquid chromatography(HPLC)before operation and 24 hours after operation,and urinary intestinal fatty acid binding protein(IFABP)was measured by enzyme linked immunosorbent assays(Elisa).Results The HR and MAP values in both groups at T3-T5 showed a downward trend,which in research group at T3-T5 were significantly lower than those in control group(P<0.05).The FLACC scores in both groups at different time points were decreased,moreover,which in research group were significantly lower than those in control group(P<0.05).After operation,8 patients in research group and 18 patients in control group were given analgesics after operation.The postoperative use rate of analgesics in research group was significantly lower than that in control group(P<0.05).In addition the levels of L/M and IFABP in both groups after operation were significantly higher than those before operation,moreover,which in research group were significantly lower than those in control group(P<0.05).C

关 键 词：儿童 腹股沟斜疝 右美托咪定 神经阻滞 肠黏膜屏障 

分 类 号：R656.22[医药卫生—外科学]