小儿术后罗比卡因自控硬膜外镇痛效果观察

Effects of patient-controlled epidural analgesia with ropivacaine for post-operative analgesia in children

目的:观察低浓度罗比卡因复合小剂量芬太尼、咪唑安定、地塞米松及昂丹司琼用于小儿术后自控硬膜外镇痛(PCEA)的效果。方法:择期行尿道成形术的患儿44例随机平均分成A组(镇痛液组成:1g/L罗比卡因+芬太尼0.001g/L+咪唑安定0.07mg/kg+地塞米松5mg+昂丹司琼4mg)和B组(镇痛液不加咪唑安定)。观察2组镇痛镇静效果;监测循环、呼吸、血氧饱和度;记录下肢运动评分,胃肠功能恢复时间,总PCEA次数及不良反应发生情况。结果:2组镇痛效果均良好,差异无统计学意义(P>0.05);镇静效果各时点A组均优于B组(P<0.001);总PCEA次数A组明显少于B组(P<0.001)。2组循环、呼吸、血氧饱和度均正常,手术前后变化组间比较差异无统计学意义(P>0.05)。2组胃肠功能恢复时间及Bromage评分无差异。结论:小儿术后低浓度罗比卡因复合液PCEA,镇痛效果好,不良反应发生率低。镇痛液加用咪唑安定效果更佳。

Aim: To study the effects of low GAAB2 dose ropivacaine combinated with fentanyl, midazolam, dexamethasone and ondansetron for pediatric postoperative analgesia with patient controlled epidural analgesia (PCEA). Methods: fourty-four ASAⅠ~Ⅱpatients aging 3~6 years and weighing 11~23 kg,were randomly divided into two groups,22 in each group. PCEA mixture of group A consisted of 1 g/L ropivacaine,0.001 g/L fentanyl, 0.07 mg/kg midazolam, 5 mg dexamethasone and 4 mg ondansetron.That of group B consisted of the same drugs without midazolam. Basal infusion was 2 ml/h supplemented with patient-controlled boluses (bolus dosage:0.5 ml,lockout time:30 min). The pain visual analogue scale(VAS),sedation scores, modified bromage score(MBS), HR, RR, SpO_2, electrocardiogram,intestines and stomach function resume time after operation and side effect were recorded at 4 h,20 h,30 h,and 48 h after operation.Results: The analgesia efficacy was satisfactory in both groups.The sedation score was significantly higher in group A compared with that in group B(P<0.001). The other parameters had no significant difference between the 2 groups(P>0.05)Conclusion: The low-dose ropivacaine combinated with fentanyl, midazolam, dexamethasone and ondansetron for pediatric postoperative analgesia with PCEA is highly effective and safe.