不同剂量右美托咪定混合罗哌卡因腰丛阻滞应用于小儿髋关节手术的效果比较  

Comparison of different doses of dexmedetomidine combined with ropivacaine for lumbar plexus block in hip surgery in children

作　　者：陈默曦[1] 高晓云 徐成 吴强[1] 许涛[1] 江伟[1] CHEN Moxi;GAO Xiaoyun;XU Cheng(Department of Anesthesiology,Shanghai Jiao Tong University Affiliated Sixth People’s Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院麻醉科,200233

出　　处：《临床外科杂志》2022年第6期514-517,共4页Journal of Clinical Surgery

摘　　要：目的评价腰丛阻滞时应用不同剂量的右美托咪定(dexmedetomidine,DEX)混合罗哌卡因,在小儿髋关节手术中的临床镇痛效果。方法我院2021年4月~2022年2月发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患儿60例,均需行择期髋关节切开复位、骨盆和股骨截骨矫形术,采用超声引导下腰丛阻滞复合全身麻醉。根据局麻药构成,按照随机数字表法将患儿分为3组,单纯0.2%罗哌卡因组(R组)、0.2%罗哌卡因+0.5μg/kg DEX组(0.5DEX组)、0.2%罗哌卡因+1μg/kg DEX组(1DEX组)。比较术中舒芬太尼用量、麻醉后监测治疗室(post anesthesia care unit,PACU)舒芬太尼用量、术后东安大略儿童医院疼痛评分(Children’s Hospital of Eastern Ontario Pain Scale,CHEOPS)、术中低血压、心动过缓、术后镇静过度、恶心呕吐的发生率。结果3组手术时间、术中出血量、输血率比较,差异无统计学意义(P>0.05)。0.5DEX组和1DEX组术中舒芬太尼用量、术后12小时和24小时的CHEOPS评分低于R组,差异有统计学意义(P<0.05),但DEX组间比较,差异无统计学意义(P>0.05)。3组PACU舒芬太尼用量、术中低血压、心动过缓、术后镇静过度、恶心呕吐的发生率比较,差异均无统计学意义(P>0.05)。结论一定剂量的右美托咪定混合罗哌卡因应用于腰丛阻滞较单纯罗哌卡因在小儿髋关节术后镇痛时间更久,但未见明显剂量依赖性作用,无明显不良反应。Objective To evaluate the clinical analgesic effect of different doses of dexmedetomidine(DEX)mixed with ropivacaine in hip surgery in children.Method 60 children aged 2-8 years(inclusive)were selected with developmental dysplasia of the hip(DDH)diagnosed,who needed open reduction of hip joint and osteotomy of pelvis and femur.Ultrasonic-guided lumbar plexus block combined with general anesthesia was used.According to the composition of local anesthetics,children were randomly divided into three groups:simple 0.2%ropivacaine group(R group),0.2%ropivacaine+0.5μg/kg DEX group(0.5 DEX group)and 0.2%ropivacaine+1μg/kg DEX group(1 DEX group).The dosage of sufentanil used during operation,the dosage of sufentanil used in Post anesthesia care unit(PACU),postoperative Children’s Hospital of Eastern Ontario Pain Scale(CHEOPS),intraoperative hypotension,bradycardia,postoperative excessive sedation,nausea and vomiting were observed.Result There was no significant difference in general information,operation time,intraoperative bleeding volume and blood transfusion rate among the three groups(P>0.05).The dosage of sufentanil used during operation and the scores of CHEOPS 12 and 24 hours after operation in 0.5 DEX group and 1 DEX group were significantly lower than those in R group(P<0.05),but there was no significant difference between the two DEX groups(P>0.05).There was no significant difference in the dosage of sufentanil used in PACU,intraoperative hypotension,bradycardia,postoperative excessive sedation,nausea and vomiting among the three groups(P>0.05).Conclusion A certain dose of DEX combined with ropivacaine for lumbar plexus block provides better postoperative analgesia than ropivacaine alone in children undergoing hip surgery,and there is no obvious dose-dependent effect and no obvious side effects.

关 键 词：右美托咪定 腰丛阻滞 超声引导 儿童 

分 类 号：R726.1[医药卫生—儿科]