右美托咪定复合罗哌卡因骶管阻滞在小儿腹腔镜疝手术中的应用

Application of caudal dexmedetomidine combined with ropivacaine to laparoscopic inguinal hernia surgery in children

目的探讨右美托咪定（dexmedetomidine，Dex）复合罗哌卡因骶管阻滞在腹腔镜下小儿腹股沟疝手术中的作用。方法采用随机数字表法将52例斜疝患儿分为两组（每组26例）：A组，Dex1μg／kg复合0．25％罗哌卡因1ml／kg骶管阻滞；B组，0．25％罗哌卡因骶管阻滞组。记录两组患儿麻醉前（T0）、骶管阻滞后5min（T1）、切皮时（T2）、手术结束时（T3）、拔气管导管时（T4）、苏醒后10min时（B）的MAP和HR，观察术后苏醒时间、苏醒时躁动发生率、躁动评分、术后镇痛评分、术后追加镇痛药的发生率及副作用。结果A组HR在T4时显著低于B组[（106±12）次／min比（117±12）次/min]（P〈0.05）。与B组比较，A组苏醒期躁动发生率[3．8％比23．1％]、躁动评分[（1．9±0．6）分比（3．1±O07）分]和术后4、8、12、16hFLACC疼痛评分[（1．1±0．6）分比（2．2±0．7）分、（1．2±0．6）分比（3．8±0．9）分、（2．3±0．6）分比（4．2±0．7）分、（2．6±0．9）分比（3．8±0．8）分]均降低（P〈0．05）；两组苏醒时及术后2、24h的FLACC疼痛评分差异无统计学意义（P〉0．05）。B组术后使用镇痛药曲马多为4例，A组无使用曲马多者（P〈0．05）。两组均未发生明显的副作用。结论与单独使用罗哌卡因相比，Dex复合罗哌卡因骶管阻滞用于腹腔镜下小儿腹股沟疝手术能降低拔管时的应激反应，减少小儿苏醒期躁动，明显延长罗哌卡因骶管阻滞的术后镇痛时间。

Objective To investigate the effect of caudal dexmedetomidine （Dex） combined with ropivacaine on laparoscopic inguinal hernia surgery in children. Methods Fifty-two children undergoing inguinal hernia surgery were divided randomly into two groups with 26 cases in each. After intravenous induction each patient received a single caudal dose： group A （n=26） received 0.25% levobupivacaine（1 ml/kg） plus Dex （ 1 μg/kg）, group B（n=26） received 0.25% levobupivacaine （1 ml/kg）. MAP and HR were recorded before anesthesia（T0）, at 5 min after caudal block（T1）, the time of skin incision（T2）, the end of surgery（T3）, the time of extubation（T4） and 10 min after waking up（T5）. The awake time, the incidence of restlessness and restless score during recovery period, postoperative pain scale, the need for additional analgesia agents and adverse reactions were recorded. Results The HR in group A was lower at T4 than that in group B [（106±12） bpm vs （117±12） bpm]（P〈0.05）. Compared with group B, in group A the incidence of restlessness（3.8% vs 23.1%） and restless score in recovery period[ （1.9±0.6） vs （3.1±0.7）], the pain assessment scores at 4, 8, 12, 16 h after operation [（1.1±0.6） vs （2.2±0.7）, （1.2±0.6） vs （3.8±0.9）, （2.3±0.6） vs （4.2±0.7）, （2.6±0.9） vs （3.8±0.8）] were significantly lower（P〈0.05）. The difference of the pain assessment scores at 2, 24 h after operation and in recovery period between two groups was not significant. The number of patients using tramadol in group B was higher than that in group A （4 vs 0） （P〈0.05）. No obvious adverse reactions were found in the two groups. Conclusions Compared with using ropivacaine alone, caudal Dex combined with ropivacaine for laparoscopic pediatric inguinal hernia surgery can reduce the stress response to tracheal extubation, decrease the incidence of agitation during waking-up period and prolong the duration of analgesia by ropivacaine caudal block after operation.