右美托咪定滴鼻联合腰方肌阻滞对小儿腹部手术术后疼痛的影响  

Effect of Dexmedetomidine Nasal Drip Combined with Quadratus Lumborum Block on Postoperative Pain in Pediatric Abdominal Surgery

作　　者：罗欢欢[1] 邓国男 林晓峰[1] 陈文雅 罗德兴[1] LUO Huanhuan;DENG Guonan;LIN Xiaofeng;CHEN Wenya;LUO Dexing(Department of Anesthesiology,Huizhou Central People′s Hospital,Huizhou,Guangdong Province,516000 China)

机构地区：[1]广东省惠州市中心人民医院麻醉科,广东惠州516000

出　　处：《中外医疗》2023年第18期125-128,153,共5页China & Foreign Medical Treatment

基　　金：惠州市科技计划项目(210328224571670)。

摘　　要：目的探讨右美托咪定滴鼻联合腰方肌阻滞对小儿腹部手术后疼痛的影响。方法随机选取2021年1月—2023年1月于惠州市中心人民医院行腹部手术的90例患儿为研究对象,随机均分为右美托咪定(D)组、腰方肌阻滞(Q)组和右美托咪定联合腰方肌阻滞(DQ)组,每组30例。D组用1μg/kg右美托咪定滴鼻;Q组用0.25%罗哌卡因;DQ组用D组和Q组的方案联合使用。分别记录切皮时(T_(1))、切皮15 min(T_(2))、术毕时(T_(3))的平均动脉压(MAP);观察术后3组拔管时间并进行镇静躁动(SAS)评分,记录术后1 h(T_(5))、术后6 h(T_(6))、术后12 h(T_(7))、术后24 h(T_(8))、术后48 h(T_(9))的FLACC评分。结果D组在T_(3)时间点的平均MAP为(71.50±5.72)mmHg,高于DQ组(68.60±4.84)mmHg,差异有统计学意义(P<0.05)。与Q组相比,D组和DQ组的术后拔管时间(T_(4))明显更长,差异有统计学意义(P<0.05)。3组SAS评分比较,差异无统计学意义(P>0.05)。3组T_(5) FLACC评分比较,差异有统计学意义(P<0.05);与DQ组相比,D组和Q组在T_(6) FLACC评分更高,差异有统计学意义(P<0.05);D组与DQ组在T_(7)、T_(8) FLACC评分比较,差异有统计学意义(P<0.05)。结论在小儿腹部手术中应用右美托咪定联合腰方肌阻滞能有效的减轻术后24 h的疼痛,效果优于单独应用右美托咪定或腰方肌阻滞,但右美托咪定的使用会延长术后拔管时间。Objective To observe the effect of dexmedetomidine nasal drip combined with quadratus lumborum block on pain after abdominal surgery in pediatric patients.Methods 90 children who underwent abdominal surgery in Huizhou Central People′s Hospital from January 2021 to January 2023 were randomly selected as the study subjects,and were randomly divided into dexmedetomidine(D)group,lumbar muscle block(Q)group,and dexmedetomidine combined with lumbar muscle block(DQ)group,with 30 patients in each group.In D group,1μg/kg of dexmedetomidine,0.25%of ropivacaine in Q group;in DQ group,a combination of D group and Q group.The mean arterial pressure(MAP)was recorded at(T_(1)),15 min(T_(2)),and(T_(3));extubation time(T_(4))and sedative agitation(SAS)at 1 h(T_(5)),6 h(T_(6)),12 h(T_(7)),24 h(T_(8))and 48 h(T_(9)).Results The mean MAP at T_(3) was(71.50±5.72)mmHg,which was higher than the DQ group(68.60±4.81)mmHg,the difference was statistically significant(P<0.05).Post-operative extubation time(T_(4))was significantly longer in D group and DQ group compared to Q group,the difference was statistically significant(P<0.05).Comparison of the SAS scores in the 3 groups,the difference was not statistically significant(P>0.05).Comparison of the T_(5) FLACC scores in the 3 groups,the difference was statistically significant(P<0.05).Compared with the DQ group,the D group and Q group had higher T_(6) FLACC scores,and the difference was statistically significant(P<0.05);D group was compared with the DQ group in the T_(7) and T_(8) FLACC scores,the difference was statistically significant(P<0.05).Conclusion The application of dexmedetomidine combined with quadratus lumborum block in pediatric abdominal surgery can effectively reduce pain at 24 hours after surgery,and the effect is better than that of dexmedetomidine or quadratus lumborum block alone,but the use of dexmedetomidine prolongs the time of postoperative extubation.

关 键 词：右美托咪定 腰方肌阻滞 小儿 腹部手术 

分 类 号：R4[医药卫生—临床医学]