多模式镇痛在患儿先天性髋关节脱位矫正术快速康复中的应用

Effects of multimodal analgesia on fast track surgery in children with developmental dislocation of the hip surgery

目的 观察基于快速康复外科理念的多模式镇痛在患儿先天性髋关节脱位手术治疗中的应用。方法 择期行髋关节脱位手术患儿90例,年龄1~7岁,随机分为三组,每组30例。A组采用静-吸复合全麻;B组采用静-吸复合全麻复合骶管阻滞,即麻醉诱导后骶管注射0.25%罗哌卡因1ml/kg;C组在B组的基础上于手术前15min肛塞对乙酰氨基酚30~35mg/kg。三组患儿术后均采用舒芬太尼静脉自控镇痛（PCIA）。分别记录患儿术后苏醒即刻（T1）、4h（T2）、8h（T3）、12h（T4）、24h（T5）、36h（T6）、48h（T7）的FLACC疼痛评分和Ramsay镇静评分,以及苏醒即刻PAED躁动评分。结果 与A组比较,B组和C组T1~T6时FLACC评分明显降低,T1、T2时Ramsay评分明显升高,T1时PAED评分明显降低（P〈0.05）;T7时C组FLACC评分明显降低（P〈0.05）。与B组比较,T4、T5、T7时C组FLACC评分明显降低（P〈0.05）。结论 骶管阻滞、肛塞对乙酰氨基酚联合PCIA用于患儿先天性髋关节脱位矫正术可增强术后镇痛效果,减少苏醒期躁动的发生,利于快速康复。

Objective To investigate the effects of muhimodal analgesia on fast track surgery in children with developmental dislocation of the hip. Methods Ninety patients, aged 1 to 7 years, with developmental dislocation of the hip undergoing surgery were randomly divided into 3 groups（n= 30 each）： combined inhalation and intravenous anesthesia （group A）, combined inhalation and intravenous anesthesiaff-eaudal block group （group B）, combined inhalation and intravenous anesthesiaff- caudal blockq-paracetamol group （group C）. Group C patients rectally received paracetamol 30-35 mg/kg at 15 rain before operation. After anesthesia induction, patients in groups A and 13 received 0.25% ropivaeaine 1 ml/kg in caudal canal. The patients received 48 h of PCIA after surgery. The background rate of PCIA was 2 ml/h bolus dose 2 ml, lock-out interval 15 rain and loading dose 4 ml. FLACC and Ramsay score were recorded respectively immediately after emergence （T1）, 4 h （T2）, 8 h （T3）, 12 h （T4）, 24 h （T5）, 36 h （T6）,48 h （T7） after the operation. PAED score at T1 was recorded. Results Compared with group A, FLACC score at T1-T6 was significantly decreased and Ramsay score at T1, T2 was significantly increased and PAED score at T1 was significantly decreased in group B and C;FLACC score at T7 was decreased in group C （P〈0.05）. Compared with group B, FLACC score at T4 ,T5 ,T7 was significantly decreased in group C （P〈0. 05）. Conclusion Multimodal analgesia including caudal block, paracetamol and PCIA can improve postoperative analgesia, decrease the incidence of emergence agitation, and promote recovery.