不同剂量右美托咪定复合罗哌卡因对小儿骶管阻滞效应的比较

Comparison of Different Doses of Dexmedetomidine Added to Ropivacaine on the Effect of Caudal Block in Pediatrics

目的：比较不同剂量右美托咪定复合罗哌卡因对小儿骶管阻滞效应的影响，并探讨右美托咪定的合适剂量。方法：选取本院60例1~7岁择期行腹股沟疝修补术或隐睾下降固定术的患儿，按照随机数字表法将其均分为R组、RD1组和RD2组各20例，R组给予0.25%罗哌卡因1 ml/kg，RD1组相同局麻药中加入右美托咪定1μg/kg，RD2组加入2μg/kg。观察比较三组术中七氟烷维持浓度、苏醒期行为状态评分、苏醒期躁动发生率、术后镇静状态评分、有效镇痛时间、需追加镇痛的比例、睡眠质量、麻醉恢复情况及术后并发症等。结果：与R组比较，RD1组和RD2组的术中七氟烷维持浓度、苏醒期行为状态评分、苏醒期躁动、术后镇静状态评分、有效镇痛时间、需追加镇痛的例数及次数、睡眠质量等比较差异均有统计学意义（P〈0.05或P〈0.01）。RD2组与RD1组比较，术中七氟烷维持浓度、苏醒期行为状态评分、术后有效镇痛时间、需追加镇痛情况比较差异均有统计学意义（P〈0.05）。三组麻醉恢复情况及并发症发生率比较差异均无统计学意义（P〉0.05）。结论：0.25%罗哌卡因1 ml/kg中加入右美托咪定1或2μg/kg行小儿骶管阻滞，能明显增强阻滞效果，减少七氟烷用量，减少苏醒期躁动，术后早期维持适度镇静，显著延长术后镇痛时间，提高睡眠质量，且不影响麻醉恢复及增加并发症。与1μg/kg右美托咪定相比，2μg/kg不仅同样安全而且效果更好。

Objective：To compare the different doses of dexmedetomidine（DEX）combined with ropivacaine on the effect of pediatric caudal block,and determine the suitable dosage of DEX.Method：Sixty children（ASAⅠ）aged 1-7 years scheduled for elective inguinal hernia repair or orchidopexy were randomly randomly divided into the group R,the group RD1 and the group RD2,20 cases in each group.The group R received a caudal injection of 0.25%ropivacaine 1 ml/kg,the group RD1 received the same dose of ropivacaine mixed with DEX 1μg/kg,and the group RD2 mixed with DEX 2 μg/kg.The end-tidal sevoflurane concentration（ET-sevo）,emergence behavior state score,incidence of emergence agitation（EA）,postoperative sedation score,duration of postoperative analgesia,the proportion of requirement for additional analgesics,quality of sleep,recovery from anesthesia and postoperative complications among the three groups were observed and compared.Result：The ET-sevo,emergence behavior state score,incidence of EA and the proportion of requirement for additional analgesics were significantly lower,the quality of sleep was significantly better,the postoperative sedation score was significantly higher and the duration of postoperative analgesia was significantly longer in Group RD1 and Group RD2 compared with Group R,the differences were statistically significant （P〈0.05 or P〈0.01）.Compared to Group RD1,the ET-sevo,emergence behavior state score,duration of postoperative analgesia and the proportion of requirement for additional analgesics in Group RD2 had statistically significant differences too（P〈0.05）.But recovery from anesthesia and postoperative complications had no statistically significant difference in all groups（P〉0.05）.Conclusion：Addition of DEX 1 or 2μg/kg to 0.25%ropivacaine（1 mL/kg）can significantly improve the efficacy of pediatric caudal block,reduce sevoflurane requirements and the incidence of EA,maintain moderate sedation during the early post-operative period,improve the quality of sleep,significantly prolong the duration of postoperative analgesia,but don’t affect the recovery and increase the complications of anesthesia.Compared to addition of DEX 1μg/kg,2μg/kg not only has same security but better efficacy.