多模式镇痛在脑瘫下肢矫形术中的应用

Application of Multimodal Analgesia in Lower Extremity Orthopedic Surgery for Patients with Cerebral Palsy following Spasm

目的观察多模式镇痛在脑瘫患儿下肢矫形术中的应用效果。方法选择100例在静吸复合全麻下接受脑瘫下肢矫形术的患儿,随机分成对照组(C组,n=50)和多模式镇痛组(M组,n=50)。患儿多为痉挛型或伴随痉挛症状。M组在手术开始前15 min接受小剂量氯胺酮(0.25 mg/kg)静脉注射、切皮前用0.25%盐酸罗哌卡因对手术切口进行局部浸润并伴随瑞芬太尼(0.2μg/kg/min)持续输注舒芬太尼(0.05μg/kg/h),C组不做上述处理。两组术后均使用一次性静脉镇痛泵。观察两组术后镇痛效果和不良反应。结果 C组脱落4例。M组术后镇痛效果好(P<0.05),医生和患儿陪护的满意度高(P<0.001)。两组术后不良反应发生率无显著性差异(P>0.05)。结论多模式镇痛能够增加脑瘫患儿下肢矫形术的术后镇痛效果,并且安全性良好。

Objective To observe the application of multimodal analgesia（MA） in lower extremity orthopedic surgery（LEOS） for patients with cerebral palsy（CP）. Methods 100 CP patients following spasm undergoing LEOS under combined general anesthesia were randomly assigned into group C（n=50） and group M（n=50）. In group M, the methods including a small dose of intravenous ketamine（0.25 mg/kg） 15 minutes before skin incision, 0.25% ropivacaine hydrochloride in surgical area with infiltration anesthesia just before skin incision,and an intravenous infusion of sufentanil（0.05 μ g/kg/h） combined with remifentanil（0.2 μ g/kg/min） were performed. In group C, the methods mentioned above were not performed. The intravenous analgesia pump for single-use was prescribed for the patients in both groups. The postoperative analgesic effect（PAE） and side effects were observed. Results 4 dropped in group C. PAE in group M was significantly superior to that in group C（P〈0.05）, and the doctors as well as the caretakers for the patients were more satisfactory with the outcome（P〈0.001）.There was no significantly difference in the side effects between two groups（P〈0.05）. Conclusion MA could increase PAE in LEOS for CP patients following spasm and the safety was not influenced.