辅助局部麻醉对唇腭裂整复术后镇痛效果的研究  

Analgesic effects of local anesthesia after cleft lip and palate repair

作　　者：裴玲 曾妮 杨超[1] 王 何苗[1] 罗强 石冰[1] 郑谦[1] Pei Ling;Zeng Ni;Yang Chao;Wang Yan;He Miao;Luo Qiang;Shi Bing;Zheng Qian(State Key Laboratory of Oral Diseases&National Clinical Research Center for Oral Diseases&Dept.of Cleft Lip and Palate Surgery,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China;State Key Laboratory of Oral Diseases&National Clinical Research Center for Oral Diseases&Dept.of Anesthesiology,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China)

机构地区：[1]口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院唇腭裂外科,成都610041 [2]口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院麻醉科,成都610041

出　　处：《国际口腔医学杂志》2022年第6期657-662,共6页International Journal of Stomatology

摘　　要：目的 比较全身麻醉术中辅助不同方法的局部麻醉对唇腭裂整复手术术后疼痛的影响。方法 将2021年6月-2022年1月在四川大学华西口腔医院唇腭裂外科进行唇腭裂手术的92例2个月~6岁的患儿作为研究对象,根据全身麻醉术中辅助局部麻醉方法的不同分为3组。对照组:术区局部注射生理盐水;浸润组:术区局部浸润麻醉;阻滞组:双侧颧上颌入路上颌神经阻滞麻醉。局部麻醉药为甲磺酸罗哌卡因。3组患者术后2 h时常规给予对乙酰氨基酚混悬滴剂口服镇痛。记录并比较患者全身麻醉过程中七氟烷及舒芬太尼的使用量;记录术前10、5 min、手术开始时及手术开始后30 min内患儿的血压及心率变化;记录患儿回麻醉复苏室后24 h内按一定时间间隔选定的14个观察时间点的疼痛评分及中重度疼痛患儿数量。结果 各组间术中七氟烷、舒芬太尼的使用量无显著性差异,舒芬太尼用量为(0.34±0.09)μg·kg^(-1);各组间血压及心率变化差异无连续时间点的统计学意义,对照组与浸润组在回麻醉复苏室后3 h时疼痛评分差异有统计学意义,阻滞组与浸润组在回麻醉复苏室后4 h时中重度疼痛人数差异有统计学意义,其余各组间术后疼痛评分及中重度疼痛人数差异无统计学意义;浸润组与阻滞组在回麻醉复苏室后8~16 h出现疼痛评分及中重度疼痛人数上升现象,而对照组在该时间段内呈持续下降趋势。结论 在使用常规剂量舒芬太尼(0.34±0.09)μg·kg^(-1)的全身麻醉条件以及对乙酰氨基酚术后镇痛的条件下,增加局部麻醉不能为唇腭裂患儿带来更好的镇痛效果。Objective This study aimed to compare the effect of different local anesthesia during general anesthesia on postoperative pain relief after cleft lip and palate(CLP)surgery.Methods A total of 92 CLP children at the age ranging from 2 months to 6 years,who were admitted to the hospital from June 2021 to January 2022,were selected as objects.All patients were divided into three groups as follows:control group,local injection of normal saline preoperative;infiltration group:local infiltration anesthesia preoperative;and block group,bilateral suprazygomatic maxillary nerve block preoperative.All patients received sufentanil for general analgesia and acetaminophen 2 h postoperative.The administration of sevoflurane and sufentanil during general anesthesia was recorded.Hemodynamic changes in patients 10 min before surgery,5 min before surgery,at the beginning of surgery,and 30 min after the beginning of surgery were collected.FLACC scores were also recorded from the time of transferring to the post-anesthesia care unit(PACU)to 24 h after surgery.The number of children with moderate and severe pain at each observation time was recorded.Results No significant difference was found in the dosage of sevoflurane and sufentanil[(0.34±0.09)μg·kg^(−1)]among all groups.No significant difference was also found in blood pressure and heart rate at continuous time points among all groups.A statistical difference in FLACC score was observed between the control group and the infiltration group at 3 h after transferring to PACU.A statistical difference was also found in the number of patients with moderate and severe pain between the block group and the infiltration group at 4 h after transferring to PACU.The FLACC score and the number of patients with moderate and severe pain increased in the infiltration group and the block group 8-16 h after transferring to PACU,whereas the control group showed a continuous downtrend during this period.Conclusion Under the condition of conventional dose of sufentanil[(0.34±0.09)μg·kg^(−1)]

关 键 词：唇腭裂整复术 术后镇痛 局部浸润麻醉 上颌神经阻滞 反跳痛 

分 类 号：R782.2[医药卫生—口腔医学]