舒芬太尼用于婴幼儿先天性巨结肠Soave手术骶管阻滞的临床研究

The clinical research of sufentanyl combined with local anesthetic caudal block on Soave operation of congenital Hirschsprung' disease in children

目的研究婴幼儿先天性巨结肠Soave手术时舒芬太尼用于骶管阻滞的麻醉及镇痛效果。方法 40例患儿随机分成对照组(C组:0.8%利多卡因+0.25%罗哌卡因)和舒芬太尼组(S组:0.8%利多卡因+0.25%罗哌卡因+舒芬太尼0.5μg/kg),气管插管后行单次骶管阻滞,异氟醚吸入维持。观察两组气管插管前(T0)、骶管阻滞后(T1)、扩张肛门(T2)、游离肠管(T3)及拔管后5 m in(T4)患儿的心率(H R)和平均动脉压(M AP)变化,比较术中异氟醚维持值、肛门松驰程度及苏醒时间,术后2、4、8、16和24 h镇痛、镇静评分及不良反应。结果 S组与C组比较:T2、T3、T4患儿H R、M AP低(P<0.05),术中异氟醚维持值低(P<0.05),苏醒时间短(P<0.05),术后2、4、8 h R am say镇静评分高(P<0.05),FLAC C镇痛评分各时点低(P<0.05)。两组术后尿潴留、皮肤瘙痒等不良反应的发生率无差异。结论舒芬太尼配伍利多卡因、罗哌卡因骶管阻滞用于婴幼儿先天性巨结肠Soave手术,可提供良好的术中麻醉及手术后镇痛、镇静效果。

【Objective】 To study the effects of anesthesia and analgesia of sufentanly combined with local anesthetic caudal block on the soave operation of congenital hirschsprung＇disease on children.【Methods】 40 patients were randomly divided into control group（C group： 0.8% lidocaine＋0.25% ropivacaine） and sufentanly group（S group： 0.8% lidocaine＋0.25% ropivacaine＋sufentanyl 0.5μg/kg）,all patients accepted single caudal block after tracheal intubation and inhaled isoflurane only at intra-operation.The heart rate,mean artery pressure of two groups were compared before intubation（T0）,after caudal block（T1）,expanded anus（T2）,seperated colon（T3）,after extubation 5 min（T4）.The mean end-tidal isoflurane concentration,the grade of anus laxity,patients awaking time,scores of analgesia and sedation postoperative were compared between the two groups.【Results】 The patients＇ heart rate,mean artery pressure were significant lower in S group than that of C group at the T2,T3,T4.The mean end-tidal isoflurane concentration was significant lower and the awaking time was shorter in S group than that of C group.The scores of Ramsay sedation at postoperative 2,4 and 8 h were significant higher and the scores of FLACC analgeisa at all postoperative time points were significant lower in S group than that of C group.There were not statistic difference of incidence of adverse effect including urine retention,skin pruritus,vomit and respiratory depression between two groups.【Conclusion】 Sufentanly combined with local anesthetic caudal block on the soave operation of congenital hirschsprung＇disease on children can provide satisfactory anesthesia effect,postoperative analgesia and sedition action.