不同剂量吗啡与丙泊酚联合臂丛神经阻滞在小儿上肢手术中的应用效果  

Effect of Different Doses of Morphine and Propofol Combined with Brachial Plexus Block in Upper Limb Surgery in Children

作　　者：张军 高飞 张瑜[2] ZHANG Jun;GAO Fei;ZHANG Yu(Anesthesiology Department of Xianyang Rainbow Hospital,Xianyang Shaanxi 712021)

机构地区：[1]咸阳彩虹医院麻醉科,陕西咸阳712021 [2]陕西中医药大学第二附属医院手术室麻醉科,陕西咸阳712000

出　　处：《医学临床研究》2022年第11期1647-1649,1653,共4页Journal of Clinical Research

摘　　要：【目的】探讨不同剂量吗啡与丙泊酚联合臂丛神经阻滞在小儿上肢手术中的应用效果。【方法】122例拟行上肢手术的患儿,随机分为两组,每组61例。对照组给予0.05~0.1 mg吗啡和4~12 mg/h的丙泊酚,观察组给予0.5μg/kg吗啡和4~12 mg/h的丙泊酚,两组均行臂丛神经阻滞。比较两组患儿恢复苏醒时间、恢复自主呼吸时间和视觉模拟评分法(VAS)评分,术前(T_(1))、术毕(T_(2))、术后24 h(T_(3))的血氧饱和度、心率,血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)水平以及麻醉药物相关不良反应。【结果】两组患儿恢复自主呼吸时间、VAS评分比较,差异无统计学意义(P>0.05),观察组患儿恢复苏醒时间短于对照组(P<0.05)。两组患儿各时刻点血氧饱和度比较,差异无统计学意义(P>0.05),两组患儿T_(2)、T_(3)时刻心率均低于组内T_(1)时刻,且观察组低于对照组(P<0.05)。两组患儿T_(1)时刻AngⅡ、ALD水平比较,差异无统计学意义(P>0.05),两组患儿T_(2)、T_(3)时刻AngⅡ、ALD水平均高于组内T_(1)时刻(P<0.05),且观察组患儿T_(2)、T_(3)时刻AngⅡ、ALD水平均低于对照组(P<0.05)。两组患儿总不良反应发生率比较,差异无统计学意义(P>0.05)。【结论】小剂量吗啡与丙泊酚联合臂丛神经阻滞用于小儿上肢手术,有利于缩短恢复苏醒时间,缓解疼痛感,稳定患儿的血气指标,减小应激反应,且使用安全。【Objective】To investigate the effect of different doses of morphine and propofol combined with brachial plexus block in upper limb surgery in children.【Methods】A total of 122 children who received upper limb surgery in our hospital were randomly divided into two groups with 61 cases in each group.The control group was given 0.05-0.1 mg morphine and 4-12 mg/h propofol,while the observation group was given 0.5μg/kg morphine and 4-12 mg/h propofol.Brachial plexus block was performed in both groups.The recovery time,recovery time of spontaneous respiration,visual analogue scale(VAS)score,levels of oxygen saturation,heart rate,angiotensinⅡ(AngⅡ)and aldosterone(ALD)before surgery(T_(1)),0 horr(T_(2))and 24 hour(T_(3))after operation,and anesthetic related adverse reactions were compared between the two groups.【Results】There was no significant difference in the recovery time of spontaneous breathing and VAS score between the two groups(P>0.05).The surgery recovery time of children in the observation group was shorter than that in the control group(P<0.05).There was no significant difference in oxygen saturation at each time point between the two groups(P>0.05).The heart rates at T_(2) and T_(3) in the two groups were lower than those at T_(1) in the same group;And the heart rate in the observation group was lower than that in the control group(P<0.05).There was no significant difference in the levels of AngⅡand aldosterone at T_(1) between the two groups(P>0.05).The levels of AngⅡand aldosterone at T_(2) and T_(3) were higher than those at T_(1) in the group(P<0.05),and the levels of AngⅡand aldosterone at T_(2) and T_(3) in the observation group were lower than those in the control group on average(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).【Conclusion】Low doses morphine and propofol combined with brachial plexus block for upper limb surgery in children can shorten the recovery time,relieve pain,stabilize blood gas indicato

关 键 词：骨折/外科学 吗啡/投药和剂量 二异丙酚/投药和剂量 神经肌肉阻滞 儿童 

分 类 号：R683.41[医药卫生—骨科学]