超声引导下右美托咪定复合罗哌卡因腰方肌阻滞用于小儿腹腔镜肾盂成形术临床评价  

Clinical Evaluation of Dexmedetomidine Combined with Ropivacaine for Ultrasound-Guide Quadratus Lumborum Block in Pediatric Laparoscopic Pyeloplasty

作　　者：谷海飞[1] 张玉龙 成黎明[1] 张明[1] GU Haifei;ZHANG Yulong;CHENG Liming;ZHANG Ming(Kunming Children's Hospital,Kunming,Yunnan,China 650228)

机构地区：[1]云南省昆明市儿童医院,云南昆明650228

出　　处：《中国药业》2024年第20期104-107,共4页China Pharmaceuticals

基　　金：云南省昆明市卫生科技人才培养项目[2022-SW(后备)-71]。

摘　　要：目的探讨超声引导下右美托咪定复合罗哌卡因腰方肌阻滞(QLB)用于小儿腹腔镜肾盂成形术的临床效果。方法选取医院2022年6月至2023年6月收治的行腹腔镜肾盂成形术患儿74例,按随机数字表法分为观察组和对照组,各37例。两组患儿均在超声引导下行QLB,并予0.25%盐酸罗哌卡因注射液0.4 mL/kg静脉注射,观察组复合盐酸右美托咪定注射液1μg/kg静脉注射。结果与对照组比较,观察组患儿气腹后30 min、气腹后60 min、术毕时的心率和平均动脉压均显著降低;术后6,12,24,48 h时的FLACC疼痛评估量表评分均显著降低,Ramsay镇静量表评分均显著更优;术后首次补救镇痛时间显著延迟,48 h内补救镇痛例数显著减少(P<0.05)。两组患儿均未发生低血压和心动过缓不良反应,但观察组嗜睡、躁动和恶心呕吐的总发生率显著低于对照组(10.81%比43.24%,P<0.05)。结论超声引导下右美托咪定复合罗哌卡因QLB用于小儿腹腔镜肾盂成形术,有利于维持血流动力学稳定,优化术后镇痛镇静效果,减少镇痛药物的额外使用。Objective To investigate the clinical efficacy of dexmedetomidine combined with ropivacaine for ultrasound-guided quadratus lumborum block(QLB)in pediatric laparoscopic pyeloplasty.Methods A total of 74 children who underwent laparoscopic pyeloplasty in the hospital from June 2022 to June 2023 were selected and randomly divided into the observation group and the control group by the random number table method,with 37 cases in each group.The children in the two groups underwent ultrasound-guided QLB and received intravenous injection of 0.4 mL/kg of 0.25%Ropivacaine Hydrochloride Injection,on this basis,the children in the observation group received intravenous injection of 1μg/kg of Dexmedetomidine Hydrochloride Injection.Results Compared with those in the control group,the heart rate(HR)and mean arterial pressure(MAP)at 30 min after pneumoperitoneum,60 min after pneumoperitoneum,and after surgery in the observation group significantly decreased;the FLACC pain assessment scale scores significantly decreased,the Ramsay sedation scale scores were significantly better at 6,12,24,48 h after surgery;the time of the first postoperative remedial analgesia significantly delayed,and the cases of remedial analgesia within 48 h significantly decreased(P<0.05).Both groups did not experience hypotension and bradycardia,but the total incidence of drowsiness,agitation,nausea and vomiting in the observation group was significantly lower than that in the control group(10.81%vs.43.24%,P<0.05).Conclusion Dexmedetomidine combined with ropivacaine for ultrasound-guided QLB in pediatric laparoscopic pyeloplasty is beneficial for maintaining hemodynamic stability,and it can optimize postoperative analgesic and sedative effects,decrease the additional use of analgesics.

关 键 词：右美托咪定 超声引导 罗哌卡因 腰方肌阻滞 肾盂成形术 小儿 术后镇痛 

分 类 号：R969.4[医药卫生—药理学]