三种药物多模式镇痛在小儿扁桃体和腺样体切除术中的应用  

Application of three drugs multimodal analgesia in children with tonsillectomy and adenoidectomy

作　　者：姚景余 廖振鹏 陈新野[2] 杨禄坤[1] YAO Jing-yu;LIAO Zhen-peng;CHEN Xin-ye;YANG Lu-kun(Department of Anesthesiology,the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai GUANGDONG 519000,China;Department of Otolaryngology,the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai GUANGDONG 519000,China)

机构地区：[1]中山大学附属第五医院麻醉科,广东珠海519000 [2]中山大学附属第五医院耳鼻咽喉科,广东珠海519000

出　　处：《中国新药与临床杂志》2023年第5期302-305,共4页Chinese Journal of New Drugs and Clinical Remedies

基　　金：珠海市科技计划项目(ZH2202200001HJL)。

摘　　要：目的探讨不同药理作用机制药物多模式镇痛在小儿扁桃体和腺样体切除术中的应用效果。方法将择期行射频等离子刀扁桃体和腺样体切除术患儿60例随机分为对照组和多模式镇痛组,每组30例。多模式镇痛组术前静脉泵注右美托咪定0.5μg·kg^(-1)(10 min),手术结束前给予0.2%罗哌卡因局部浸润麻醉,术后2组均按需给予布洛芬口服。2组麻醉诱导和维持方案均相同。评估术后患儿的疼痛和躁动发生情况,记录拔管时间、术后不良反应发生情况等。结果与对照组比较,多模式镇痛组术后0、2、4、8、24 h各时点的FLACC量表疼痛评分和儿童苏醒期谵妄(PAED)量表躁动评分均显著降低(P<0.05),家长满意度评分显著升高(P<0.05)。2组的拔管时间和术后恶心呕吐、出血等不良反应发生率比较,差异无显著意义(P>0.05)。结论右美托咪定、罗哌卡因联合布洛芬多模式镇痛应用于小儿扁桃体和腺样体切除术可增强术后镇痛效果,减轻术后躁动。AIM To evaluate the effects of analgesic with different pharmacological mechanisms in multimodal analgesia during tonsillectomy and adenoidectomy in children.METHODS Sixty inpatient children underwent tonsillectomy and adenoidectomy were randomly divided into two groups(n=30 each).Patients in multimodal analgesia group were received intravenous dexmedetomidine 0.5μg·kg^(-1)(10 min)before operation,local infiltration around the wound with 0.2%ropivacaine during operation,and ibuprofen orally as needed after operation,while patients in control group only received ibuprofen orally as needed after operation.The anesthesia induction and maintenance programs of the two groups were the same.Postoperative pain and agitation were evaluated.The extubation time,postoperative adverse reactions,and the score of parental satisfaction were recorded.RESULTSSCompared with the control group,the face,legs,activity,cry,consolability(FLACC)scale score for pain and pediatric anesthesia emergence delirium(PAED)scale score for agitation at 0,2,4,8 and 24 h after operation were lower(P<0.05),and the score of parental satisfaction were higher(P<0.05)in the multimodal analgesia group.There was no significant difference in extubation time and the incidence of postoperative adverse reactions such as nausea,vomiting and bleeding between the two groups(P>0.05).CONCLUSION Using dexmedetomidine,ropivacaine and ibuprofen multimodal analgesia in children underwent tonsillectomy and adenoidectomy can enhance postoperative analgesia ffect and alleviate postoperative agitation.

关 键 词：镇痛 扁桃体切除术 腺样体切除术 儿童 药理作用机制 多模式镇痛 右美托咪定 

分 类 号：R766.9[医药卫生—耳鼻咽喉科] R971[医药卫生—临床医学]