右美托咪定非静脉给药途径在儿科下腹手术术后镇痛的应用

Application of Dexmedetomidine with Non-intravenous Route in Postoperative Analgesia in Pediatric Patients Undergoing Abdominal Surgery

目的:研究右美托咪定非静脉给药途径在儿科下腹术后镇痛的应用。方法:搜集我院儿科拟行下腹择期手术的患儿60例,随机分为A、B、C三组,每组各20例。B组于术前30min右美托咪定1ug/kg滴鼻,A,C组等容积生理盐水滴鼻。三组患儿均给于阿托品0.01~0.02mg/kg,利多卡因1mg/kg,丙泊酚2mg/kg,七氟醚6~8%,氧流量2L/min,待患儿睫毛反射消失置入喉罩,将七氟醚降到1~2%。A组和B组患儿骶管阻滞成功后注入0.25%罗哌卡因1m L/kg,C组给予0.25%罗哌卡因1m L/kg+右美托咪定1ug/kg,骶管阻滞给予药物总量20m L封顶。记录患儿的一般资料。记录手术时间,诱导时间,拔喉罩时间和苏醒时间。记录心动过缓、苏醒延迟、喉痉挛、尿储留和苏醒期躁动评分。记录术后4,8,12,16,20,24h镇痛评分,镇静评分,计算各组镇痛时间。结果:三组患儿一般状况差异无统计学意义(P>0.05)。三组手术时间,拔喉罩时间,苏醒时间差异不存在统计学意义(P>0.05),B组的诱导时间短于A组和C组(P<0.05)。三组患儿均无心动过缓、苏醒延迟和尿储留的发生,A组喉痉挛的发生和躁动评分高于B和C组,B,C组的镇痛时间比A组延长,C组最长(P<0.05)。术后4h镇痛评分均小于4分,镇静评分为2~3分,B,C组8h的镇痛镇静评分低于A组(P<0.05),C组12,16,20h的镇静,镇痛评分低于A,B组(P<0.05);术后24h镇痛镇静评分差异无统计学意义(P>0.05)。结论:右美托咪啶滴鼻给药诱导迅速且有早期术后镇痛镇静的作用,右美复合罗哌卡因骶管阻滞术后镇痛时间明显延长,苏醒期不良反应明显减少。

Objective: To investigate the effect of dexmedetomidine intravenous administration on postoperative analgesia in pediatric patients undergoing abdominal surgery. Methods: 60 patients who were undergoing the general anesthesia for lower abdomen surgery were randomly devided into there groups,each group20 cases. Patients in group B were received dexmedetomidine 1 ug/kg nasal drops before operation 30 min; Patients in group A,C were received volume normal saline nasal drops. The three groups were given atropine 0.01-0.02 mg/kg,lidocaine 1 mg/kg,propofol 2 mg/kg,sevoflurane 6-8%,oxygen flow 2 L/min,waiting for the eyelash reflex disappeared,placed the laryngeal mask,sevoflurane dropped to 1-2%. In group A and group B,0.25% ropivacaine 1 ml/kg was injected after the success of sacral block,group C was given 0.25%ropivacaine 1 ml/kg+ dexmedetomidine 1 ug/kg,sacral block was given total amount of 20 ml cap. 1. Each patient general information respectively were record; 2. The time of operation,induction,extubation and anesthesia awake were recorded; 3. The adverse events such as bradycardia,delayed awakening,laryngismus,urine retention were and awakening period agitation score were recorded. 4. Postoperative 4,8,12,16,20,24 hours analgesic score,sedation score and analgesia time were recorded. Results: 1. The general situation have no statistical significance( P >0.05); 2. The time of operation,extubation and anesthesia awake have no statistical significance( P >0.05),the induction time of B group are shorter than A and C groups( P <0.05); 3.All the three groups have no hypoxemia,delayed awakening and urine retentionwere; Compared with group B and C,the emergence laryngismus and awakening period agitation score were higher in group A( P < 0.05);the analgesia time were shorter,group C was the longest. 4. All the analgesic score of the three groups were less than 4 points,sedation score for 2-3 minute in postoperative 4 h. Compared with group A,analgesic and sedation score of the group B and C are lower in postoperative 8 h( P <0.05). Compared with group A and B,analgesic and sedation score of the group C were lower in postoperative 12,16,20 h( P <0.05). There was no statistical significance in postoperative 24 h( P >0.05). Conclusion: Intranasal dexmedetomidine( DEX) application used in pediatric anesthesia induction period undergoing the lower abdomen and lower extremity surgery could significantly reduce induction time and have early postoperative analgesia sedation. For caudal block,which received the ropivacaine mixed with 1 ug/kg dexmedetomidine can prolonge analgesia calm times and reduce adverse reaction during anesthesia recovery period.