右美托咪定骶管阻滞剂量差异对儿童包皮环切术后的镇痛效果比较
| 作者: |
1,2崔恩惠,
1钱燕宁
1 南京医科大学第一附属医院麻醉科，南京 210029 2 淮安市妇幼保健院麻醉科，江苏 淮安 223002 |
| 通讯: |
钱燕宁
Email: yanning_qian@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.10.019 |
| 基金: | 淮安市自然科学基金 (HABZ201731)。 |
摘要
目的：比较不同剂量的右美托咪定骶管阻滞对儿童包皮环切术后镇痛的临床疗效差异，探讨右美托咪定的适宜剂量。方法：选取江苏省淮安市妇幼保健院120例接受包皮环切术患儿，依据随机原则分为：0.25%罗哌卡因骶管阻滞组(R组)，在R组基础上+1 μg/kg右美托咪定骶管阻滞组(DR1组)，在R组基础上+2 μg/kg右美托咪定骶管阻滞组(DR2组)，在R组基础上+0.5 μg/(kg·h)右美托咪定静脉泵注组(DVR组)。分别在苏醒时、术后2，4，6，12，16，24 h的7个时间点进行FLACC(Face， Legs，Activ ity，Cr y ing，Consolability)评分；记录4组患儿手术时间、苏醒时间、苏醒时躁动评分、镇痛时间；比较4组术中不良事件和术后并发症发生率。结果：4组患儿手术时间差异无统计学意义(P>0.05)；苏醒时间R组与DR1组最短，DR2组次之，DVR组最长(P<0.05)；躁动评分DVR组与DR2组最短，DR1组次之，R组最长(P<0.05)；镇痛时间R组最短，DR1组与DVR组次之，DR2组最长(P<0.05)。苏醒时及术后2，24 h的FLACC评分4组比较均无统计学意义(P>0.05)；术后4，6， 12，16 h的FLACC评分，DR1，DR2，DVR 3组明显低于R组(均P<0.05)，DR2组FLACC评分最低(均P<0.05)，而DR1组与DVR组FLACC评分比较差异均无统计学意义(均P>0.05)。DVR组易发生血流动力学不稳定，R组易发生需镇痛补救情况。结论：2 μg/kg剂量右美托咪定复合罗哌卡因骶管阻滞对儿童包皮环切术后镇痛效果最好，苏醒期间躁动少，血流动力学稳定。
关键词：
右美托咪定；骶管麻醉；儿童；包皮环切；镇痛
Comparison of the analgesic effects of caudal block with different doses of dexmedetomidine on postoperative analgesia after pediatric circumcision
CorrespondingAuthor: QIAN Yanning Email: yanning_qian@163.com
DOI: 10.3978/j.issn.2095-6959.2018.10.019
Foundation: This work was supported by the Huai’an Natural Science Foundation, China (HABZ201731).
Abstract
Objective: To compare the effects of caudal block with different doses of dexmedetomidine on postoperative analgesia after pediatric circumcision and to determine the suitable dosage of dexmedetomidine. Methods: A total of 120 children received with circumcision in Jiangsu Huai’an Maternity and Children Hospital were chosen and divided into 4 groups randomly, which were group R (received with 0.25% ropivacaine by sacral block), group DR1 (received with 1 μg/kg dexmedetomidine and 0.25% ropivacaine by sacral block), group DR2 (received with sacral block by 2 μg/kg dexmedetomidine and 0.25% ropivacaine) and group DVR (received by 0.5 μg/kg dexmedetomidine and 0.25% ropivacaine by syringe pumps). Each group had 30 cases. The FLACC (Face, Legs, Activity, Crying, Consolability) scores of 4 groups were recorded at waking time, post-operation 2nd, 4th, 6th, 12th, 16th, 24th h respectively. The indexes of operation time, waking time, the restlessness score and the analgesic time were compared among four groups. The adverse events and the incidence of postoperative complications were compared among four groups. Results: The indexes of operation time were no different among four groups (P>0.05). The waking time of group R and group DR1 was the shortest, and the group DR2 was the medial and the group DRV was the longest (P<0.05). The FLACC scores of group DRV and group DR2 were shortest, and the group DR1 was the medial and the group R was the longest (P<0.05). The analgesic time of group R were shortest, and the group DR1 and the group DVR was the medial and the group DR2 was the longest (P<0.05). The FLACC scores of four groups at the waking time, post-operation 2nd and 24th h were no different among four groups (P>0.05). At the time-points of post-operation 4th, 6th, 12th and 16th h, the FLACC scores of group DR1, group DR2 and group DVR were lower than of group R (all P<0.05), and the FLACC scores of group DR2 were lowest (all P<0.05), but the FLACC scores of group DR1 and group DVR were no different (P>0.05). The hemodynamics indexes of group DVR was more unstable, and the need for analgesia remedies mainly occurred in group R. Conclusion: The caudal block with the dosage of 2 μg/kg dexmedetomidine combined with ropivacaine on postoperative analgesia after pediatric circumcision can gain the best analgesic effect and less restlessness and the stable hemodynamics.
Keywords：
dexmedetomidine; sacral canal anesthesia; children; circumcision; analgesia