超声引导下不同剂量罗哌卡因腰方肌阻滞用于腹腔镜手术患儿术后镇痛的效果和安全性  

Effect and Safety of Ultrasound Guided Different Doses of Ropivacaine Quadratus Lumborum Block for Postoperative Analgesia in Children Undergoing Laparoscopic Surgery

作　　者：郑妹萍 陈健龙 ZHENG Meiping;CHEN Jianlong(Sanming First Affiliated Hospital of Fujian Medical University,Sanming 365000,China;不详)

机构地区：[1]福建医科大学附属三明第一医院,福建三明365000

出　　处：《中外医学研究》2023年第3期6-10,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：福建省三明市科技计划项目(2018-S-1(1))。

摘　　要：目的:探讨超声引导下不同剂量罗哌卡因腰方肌阻滞(QLB)用于腹腔镜手术患儿术后镇痛的效果和安全性。方法:选取2020年3月—2021年6月于福建医科大学附属三明第一医院收治的需腹腔镜手术的74例患儿,按随机数表法分为对照组(n=37)和观察组(n=37),对照组给予0.4 mL/kg 0.15%罗哌卡因QLB,观察组给予0.4 mL/kg 0.25%罗哌卡因QLB,比较两组血流动力学、拔管和麻醉后恢复室(PACU)滞留时间、镇静及疼痛情况、镇痛补救、苏醒躁动和不良反应发生情况。结果:两组阻滞前、拔管时心率(HR)、动脉压(MAP)水平及拔管、PACU滞留时间比较,差异均无统计学意义(P>0.05)。两组术后4、12、24 h镇静系统(Ramsay)评分比较,差异均无统计学意义(P>0.05);两组术后12 h儿童疼痛行为量表(FLACC)评分均低于术后4 h,术后24 h FLACC评分均低于术后4、12 h,且观察组均低于对照组(P<0.05)。观察组术后首次镇痛补救时间长于对照组,术后24 h内镇痛药使用率低于对照组(P<0.05);两组苏醒躁动和不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:0.25%罗哌卡因QLB较0.15%剂量可延长患儿术后疼痛阻滞时间,减少术后止痛药的使用,且不会影响血流动力学稳定及延长苏醒和拔管时间,未增加术后苏醒躁动和不良反应的发生风险,安全性好。Objective:To discuss the effect and safety of ultrasound guided different doses of Ropivacaine quadratus lumborum block(QLB)for postoperative analgesia in children undergoing laparoscopic surgery.Method:Seventy-four cases of children who needed laparoscopic surgery in Sanming First Affiliated Hospital of Fujian Medical University from March 2020 to June 2021 were selected and divided into control group(n=37)and observation group(n=37)according to random number table method.The control group was given 0.4mL/kg 0.15%Ropivacaine for QLB,the observation group was given 0.4 mL/kg 0.25%Ropivacaine for QLB.Hemodynamics,extubation and postanesthesia care unit(PACU)retention time,sedation and pain,analgesic relief,agitation and adverse reactions were compared between two groups.Result:There were no significant differences in heart rate(HR)and arterial pressure(MAP)levels before block and at extubation,and the time of extubation and retention in PACU between two groups(P>0.05).There were no significant differences in Ramsay score at 4,12 and 24 h after operation between two groups(P>0.05).The face,legs,activity,cry,consolability behavioral tool for children(FLACC)scores of two groups at 12 h after operation were lower than those at 4 h after operation,and the FLACC scores at 24 h after operation were lower than those at 4 and 12 h after operation,and the FLACC scores of the observation group were lower than those of the control group(P<0.05).The first rescue analgesic time after operation in the observation group was longer than that in the control group,and the utilization rate of analgesics during 24 h was lower than that in the control group(P<0.05).There were no significant differences in the incidence of emergence restlessness and adverse reactions between two groups(P>0.05).Conclusion:Compared with 0.15%Ropivacaine QLB,0.25%Ropivacaine QLB can prolong postoperative pain block time,reduce the use of painkillers after surgery,it will not affect hemodynamic stability and prolong the time of awakening and extubation,it d

关 键 词：儿童 腰方肌阻滞 罗哌卡因 不同浓度 腹腔镜 

分 类 号：R726.1[医药卫生—儿科]